Economic Impact of COVID-19 Lockdown on Italian NHS: Focus on Diabetes Mellitus

Figures & data

Table 1 COVID-19 and Mortality Rate

	Cumulative Cases	Cumulative Cases/1 Million Population	Cumulative Deaths	Cumulative Deaths/1 Million Population	Mortality Rate
Italy	2,107,166	34,877	74,159	1227	3.52%
Germany	1,745,518	20,800	34,182	407	1.96%
Sweden	437,379	43,173	8727	861	1.99%
Switzerland	452,296	52,070	7645	880	1.69%
USA	20,445,654	61,588	354,215	1067	1.73%

Data available from World Health Organization on 31 December 2020.

Table 2 Event Rate in the Diabetic Population by Type of Treatment and Cost per Event

	IHD	Stroke	HHF	ESRD	Hypoglycemic Event
					Moderate	Severe
Rates in diabetic population	0.97%	0.59%	0.51%	0.054%	22%*	1.16%*
Drugs class	HR
Sulfonylureas-glinides	1.35	1.28	1.47	1	1	1
GLP1 agonists	0.91	0.65	0.65	1	0.32	0.16
SGLT2 inhibitors	1.18	0.56	0.54	0.74	0.32	0.00
Event costs
Direct cost per event	€15,949	€10,237	€11,000	€32,000	€335	€19,110
Indirect cost per event	€9775	€6274	€6742	€6650	€45	€1110

Note: *Related to treatment with sulfonylurea.

Abbreviations: IHD, ischemic heart disease; HHF, hospitalization for heart failure; ESRD, end stage renal disease; SGLT2i, sodium/glucose cotransporter-2 inhibitors; GLP1 agonists, glucagon-like peptide 1 receptor agonists.

Table 3 Drop in Diabetic Patient Visits Observed in 2020

Data on Diabetic Patients and Visits	N	∆%
Diabetic patients treated	20,491
Patients who came to visit (9 March ; 31 December 2020)	14,819
Missed visits	5672	−28
Phone visits	2438
Controlled patients	17,257
Uncontrolled patients	3234	−16

Table 4 Trend of Use of the Antidiabetic Therapies Analyzed (2018–2020)

Drugs Class	2018	2019			2020
	N	N	ΔN	Δ%	N	ΔN	%
Sulfonylureas	6,387,487	5,811,077	−576,410	−9	5,430,978	−380,099	−7
Glinides	2,206,394	1,884,195	−322,199	−15	1,684,707	−199,488	−11
Biguanide/Sulfonylureas combination	2,182,087	1,680,186	−501,901	−23	1,355,278	−324,908	−19
Total group	10,775,968	9,375,458	− 1,400,510	−13	8,470,963	−904	−10
Biguanide/SGLT2 inhibitors combination	726,915	1,030,221	303,307	42	1,245,296	215,075	21
GLP1 agonists	1,096,438	1,600,708	504,270	46	2,141,305	540,597	34
SGLT2 inhibitors	1,510,969	2,054,283	543,314	36	2,556,221	501,938	24
Total group	3,334,322	4,685,213	1,350,891	41	5,942,822	1,257,610	27

Abbreviations: SGLT2i, sodium/glucose cotransporter-2 inhibitors; GLP1 agonists, glucagon-like peptide 1 receptor agonists

Table 5 Effects of Slowdown in the Use of Innovative Antidiabetic Therapies

Events	2020		∆
	Real	Simulation	Events	Costs	Utilities
Stroke	407	188	219	€2,239,488	−13
IHD	706	566	140	€2,229,910	−7
HHF	404	159	245	€2,693,626	−12
ESRD	29	24	5	€154,984	0
Severe hypoglycemia	626	37	589	€1,124,881	−28
Moderate hypoglycemia	11,864	3775	8089	€2,709,832	−113
Total	14,036	4750	9286	€11,152,721	−173

Abbreviations: IHD, ischemic heart disease; HHF, hospitalization for heart failure; ESRD, end stage renal disease.

Table 6 Effects of Reducing Hospital Procedures and Follow-Up Visits in Diabetic Patients at Risk

Events			∆
	2019	2020	Events	Cost	Utilities
Cardiovascular mortality	11,730	11,991	261
Cardiac catherization procedures	35,494	32,509	−2984
Acute coronary sindrome	35,494	34,229	−1265
Heart failiure			1265	€13,911,423	−63
Deaths due to heart failure			190
Injections for diabetic macular edema	11,250	10,420	−830	€185,902
Amputations in patients with diabetic foot	496	714	218	€1,321,806	−21
Total				€15,419,131	−84

Figure 1 Simulation scenario results: analysis of the lockdown effects on the slowdown in innovative antidiabetic therapies use.

Notes: Base case: linear growth of innovative antidiabetic therapies consumption in 2020 compared to 2019 (direct costs); Simulation 1: linear growth of innovative antidiabetic therapies consumption used in 2020 compared to 2019 (direct costs + indirect costs); Simulation 2: double growth of innovative antidiabetic therapies consumption in 2020 compared to 2019 (direct costs); Simulation 3: double growth of innovative antidiabetic therapies consumption in 2020 compared to 2019 (direct costs + indirect costs).

Figure 2 Simulation scenario results: potential prolonged effects of restriction, simulation scenario 30, 45 and 60 days.

Figure 3 Summary of results: base case and simulation scenarios.