Endocrine Abstracts

Background: Since the last decade, the disease pattern has significantly changed around the world. Non-communicable diseases, most commonly diabetes mellitus, have become the main threat to global health. The incidence of diabetes mellitus type 2 (DM2) is rising steadily, accounting for about two-thirds of deaths in Germany. Based on a prevalence of 9 million diabetic patients per year, DM2 constitutes a considerable medical and economic burden in Germany. However, the healthcare spending and its cost drivers are not yet sufficiently known.

Aims of the study: The primary objective of this study was to describe healthcare resource use and cost development of DM2 treatment in Germany, focusing on the most significant cost drivers and opportunities for cost-savings. The secondary objective was to analyse the impact of technical progress on diabetes care.

Methods: A systematic literature search was conducted in PubMed and Embase. Additionally, publications of the national health authorities (Robert Koch Institute RKI), Federal Joint Committee (Gemeinsamer Bundesausschuss G-BA) and the German Diabetes Society (Deutsche Diabetes Gesellschaft DDG) were included. Following the PRISMA guidance, the review identified the study design, epidemiological approach, analytical perspective, and data collection approach in each of the included studies.

Results: From 1.965 records, the final sample was composed of 41 articles. Most of the studies addressed direct costs and were based on calculations by extrapolations. The annual diabetes-specific direct costs of DM2 were between 542 and 6.323 &z.euro; per patient. The most used method is the incremental or excess cost approach (1.8-fold higher costs compared to individuals without DM2). Confirmed risk factors included physical inactivity, obesity, genetic predispositions, and tobacco use. People with low social and income status had a significantly increased risk of developing DM2. The major cost drivers are demographic change with aging, exponentially increasing obesity, the availability of medications and therapies and the increased use of medical services by patients due to available treatment options of diabetic complications. Increasing prevalence, especially in childhood, is a major cost driver on its own. The preventive measures taken so far have not yet paid off. The potential financial savings from medical-technological progress are eroded by increasing age and use of medical services.

Conclusion: DM2, based on the results of this study, constitutes a considerable medical and economic burden in Germany and has a serious impact on the government health expenditures. To successfully combat diabetes and reduce health care expenditures, preventive efforts must be intensified.