The Economic Burden of Insulin-Related Hypoglycemia in Adults with Diabetes: An Analysis from the Perspective of the Italian Healthcare System

• Published in: Diabetes therapy 2018-06, Vol.9 (3), p.1037-1047
• Main Authors: Parekh, Witesh, Streeton, Sophie E., Baker-Knight, James, Montagnoli, Roberta, Nicoziani, Paolo, Marchesini, Giulio
• Format: Article
• Language: English
• Subjects: Cardiology; Care and treatment; Complications and side effects; Cost control; Diabetes; Dosage and administration; Economic aspects; Endocrinology; Health care expenditures; Health economics; Hypoglycemia; Insulin; Internal Medicine; Italy; Medical care; Medical economics; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Original Research; Physiological aspects; Risk factors
• ISSN: 1869-6953; 1869-6961
• DOI: 10.1007/s13300-018-0418-0

Introduction The aim of this analysis was to estimate the cost of insulin-related hypoglycemia in adult patients with diabetes in Italy using the Local Impact of Hypoglycemia Tool (LIHT), and to explore the effect of different hypoglycemia rates on budget impact. Methods Direct costs and healthcare resource utilization were estimated for severe and non-severe hypoglycemic episodes in Italy and applied to the population of adults with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) and their corresponding hypoglycemia episode rates (0.49 severe and 53.3 non-severe episodes per year for T1DM, and 0.09 severe and 9.3 non-severe episodes per year for T2DM). Uncertainty around model inputs was explored through sensitivity and scenario analyses. Results The direct cost of insulin-related hypoglycemia in Italy is estimated at €144.7 million per year, with €65 million attributable to severe episodes and €79.6 million due to non-severe episodes. The total cost of hypoglycemia is approximately 1.7-fold higher for T2DM (€91.7 million) than for T1DM (€53 million). The cost of a hypoglycemic episode ranges from €4.59 for a non-severe event where additional self-monitoring of blood glucose (SMBG) testing is the only cost incurred, to €5790.59 for a severe event that also requires an ambulance, A&E, hospitalization, and a visit to a diabetes specialist. A reduction in hypoglycemia event rates could result in substantial cost savings; for example, a 20% reduction in severe and non-severe hypoglycemia rates could result in a saving of €47,769 per general population of 100,000 people. Conclusions The LIHT highlights the substantial economic burden of insulin-related hypoglycemia in Italy, particularly with regards to non-severe hypoglycemia, an aspect of hypoglycemia that is often overlooked. This analysis may aid healthcare decision-making by allowing the costs of insulin therapies or diabetes self-management programs to be balanced with the savings provided by reductions in hypoglycemia. Funding Novo Nordisk, UK.