An Exploratory Research of 18 Years on the Economic Burden of Diabetes for the Romanian National Health Insurance System

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Abstract

The prevalence of diabetes mellitus (DM) rises constantly each year worldwide. Because of that, the funds allocated for the DM treatment have increased over time. Regarding the number of DM cases, Romania is among the top ten countries in Europe. Based on the National Diabetes Programme (NDP), antidiabetic drugs and other expenditures (Self-monitoring blood glucose (SMBG) test, HbA1c, insulin pumps/insulin pumps supplies) are free of charge. This programme has undergone many changes in drugs supply, in the last two decades: re-organizing the NDP, authorization of new molecules with high prices (e.g., SGLT-2 inhibitors, etc.) or new devices (e.g., insulin pumps, etc.) The main purpose of this study is to identify and analyse the impact of the DM costs on the Romanian health budget and to highlight the evolution of these costs. A retrospective longitudinal research on the official data regarding the DM costs from 2000 to 2017 was performed. The DM funds (DMF) were adjusted with the inflation rate. In this period, the average share of DMF in the total funds allocated for health programmes was 21.3 ± 3.4%, and DMF average growth rate was 25.4% (r = 0.488, p = 0.047). On the other hand, the DMF increased more than 14 times, in spite of the patients’ number having increased only about 2.5 times. Referring to the structure of DMF, the mean value of the antidiabetic drugs cost was of 96,045 ± 67,889 thousand EUR while for other expenditures it was of 11,530 ± 7922 thousand EUR (r = 0.945, p < 0.001). Between 2008 and 2017, the total DMF was 181,252 ± 74,278 thousand EUR/year. Moreover, the average patients’ number was 667,384 ± 94,938 (r = 0.73, p = 0.016), and the cost of treatment was 215 ± 36 EUR/patient/year. Even if the cost is rising, the correct and optimal treatment is a main condition for the diabetic patient’s health and for the prevention of its complications, which have multiple socio-economic repercussions.

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Most cited references 52

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Diabetes and depression: global perspectives.

Leonard Egede, Charles A. Ellis (2010)

Diabetes and depression are highly prevalent conditions and have significant impact on health outcomes. This study reviewed the literature on the prevalence, burden of illness, morbidity, mortality, and cost of comorbid depression in people with diabetes as well as the evidence on effective treatments. Systematic review of the literature on the relationship between diabetes and depression was performed. A comprehensive search of the literature was performed on Medline from 1966 to 2009. Studies that examined the association between diabetes and depression were reviewed. A formal meta-analysis was not performed because of the broad area covered and the heterogeneity of the studies. Instead, a qualitative aggregation of studies was performed. Diabetes and depression are debilitating conditions that are associated with significant morbidity, mortality, and healthcare costs. Coexisting depression in people with diabetes is associated with decreased adherence to treatment, poor metabolic control, higher complication rates, decreased quality of life, increased healthcare use and cost, increased disability and lost productivity, and increased risk of death. The coexistence of diabetes and depression is associated with significant morbidity, mortality, and increased healthcare cost. Coordinated strategies for clinical care are necessary to improve clinical outcomes and reduce the burden of illness.

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Revealing the cost of Type II diabetes in Europe.

Kenneth Jonsson, (2002)

'The Cost of Diabetes in Europe - Type II study' is the first coordinated attempt to measure total healthcare costs of Type II (non-insulin-dependent) diabetes mellitus in Europe. The study evaluated more than 7000 patients with Type II diabetes in eight countries -- Belgium, France, Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom. A bottom-up, prevalence-based design was used, which optimised the collection of data at the national level while maintaining maximum international comparability. Effort was made to ensure consistency in terms of data specification, data collection tools and methods, sampling design, and the analysis and reporting of results. Results are reported for individual countries and in aggregate for the total study population. The total direct medical costs of Type II diabetes in the eight European countries was estimated at EUR 29 billion a year (1999 values). The estimated average yearly cost per patient was EUR 2834 a year. Of these costs, hospitalisations accounted for the greatest proportion (55%, range 30-65%) totalling EUR 15.9 billion for the eight countries. During the 6-month evaluation period, 13% of the Type II diabetic patients were hospitalised, with an average of 23 days in hospital projected annually. In contrast, drug costs for managing Type II diabetes were relatively low, with antidiabetic drugs and insulin accounting for only 7% of the total healthcare costs for Type II diabetes. Type II diabetes mellitus is a common disease and the prevalence is expected to increase considerably in the future, especially in developing countries. Current comprehensive economic data on the costs of diabetes are required for policy decisions to optimise resource allocation and to evaluate different approaches for disease management.

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The cost of diabetes in Latin America and the Caribbean.

Héctor Barcelo, Cristian Aedo, Sylvia Robles … (2002)

To measure the economic burden associated with diabetes mellitus in Latin America and the Caribbean. Prevalence estimates of diabetes for the year 2000 were used to calculated direct and indirect costs of diabetes mellitus. Direct costs included costs due to drugs, hospitalizations, consultations and management of complications. The human capital approach was used to calculate indirect costs and included calculations of forgone earnings due to premature mortality and disability attributed to diabetes mellitus. Mortality and disability attributed to causes other than diabetes were subtracted from estimates to consider only the excess burden due to diabetes. A 3% discount rate was used to convert future earnings to current value. The annual number of deaths in 2000 caused by diabetes mellitus was estimated at 339,035. This represented a loss of 757,096 discounted years of productive life among persons younger than 65 years (> billion US dollars). Permanent disability caused a loss of 12,699,087 years and over 50 billion US dollars, and temporary disability caused a loss of 136,701 years in the working population and over 763 million US dollars. Costs associated with insulin and oral medications were 4720 million US dollars, hospitalizations 1012 million US dollars, consultations 2508 million US dollars and care for complications 2,480 million US dollars. The total annual cost associated with diabetes was estimated as 65,216 million US dollars (direct 10,721 US dollars; indirect 54,496 US dollars). Despite limitations of the data, diabetes imposes a high economic burden to individuals and society in all countries and to Latin American and the Caribbean as whole.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Environ Res Public Health

Journal ID (iso-abbrev): Int J Environ Res Public Health

Journal ID (publisher-id): ijerph

Title: International Journal of Environmental Research and Public Health

Publisher: MDPI

ISSN (Print): 1661-7827

ISSN (Electronic): 1660-4601

Publication date (Electronic): 21 June 2020

Publication date (Print): June 2020

Volume: 17

Issue: 12

Electronic Location Identifier: 4456

Affiliations

[1 ]Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; claudiu.morgovan@ 123456ulbsibiu.ro (C.M.); ancamaria.juncan@ 123456ulbsibiu.ro (A.M.J.); liviu.rus@ 123456ulbsibiu.ro (L.L.R.); felicia.gligor@ 123456ulbsibiu.ro (F.G.G.); anca.butuca@ 123456ulbsibiu.ro (A.B.)

[2 ]Department of Hospitality Services, Faculty of Business, “Babeș-Bolyai” University, 7 Horea St., 400174 Cluj-Napoca, Romania; smaranda.cosma@ 123456tbs.ubbcluj.ro

[3 ]Department of Medical Informatics and Biostatistics, Faculty of Medicine, “Iuliu Haţieganu” University Medicine and Pharmacy, 4 Louis Pasteur St., 400349 Cluj-Napoca, Romania

[4 ]Department of Pharmacy, University of Oradea, 29 Nicolae Jiga St., 410028 Oradea, Romania; mirela_tit@ 123456yahoo.com (D.M.T.); sbungau@ 123456uoradea.ro (S.B.)

[5 ]Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, “Iuliu Haţieganu” University Medicine and Pharmacy, 4 Louis Pasteur St., 400349 Cluj-Napoca, Romania

Author notes

[* ]Correspondence: mvaleanu@ 123456umfcluj.ro (M.V.); steliana.ghibu@ 123456umfcluj.ro (S.G.)

[†]

These authors contributed equally to this work.

Author information

Claudiu Morgovan https://orcid.org/0000-0003-2730-8729

Anca Maria Juncan https://orcid.org/0000-0002-5064-0239

Luca Liviu Rus https://orcid.org/0000-0002-3622-2815

Anca Butuca https://orcid.org/0000-0003-1540-641X

Delia Mirela Tit https://orcid.org/0000-0002-0296-6592

Simona Bungau https://orcid.org/0000-0003-3236-1292

Steliana Ghibu https://orcid.org/0000-0003-2247-4613

Article

Publisher ID: ijerph-17-04456

DOI: 10.3390/ijerph17124456

PMC ID: 7344799

PubMed ID: 32575853

SO-VID: ded3af68-e133-49a0-a071-8ced327d16d6

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

An Exploratory Research of 18 Years on the Economic Burden of Diabetes for the Romanian National Health Insurance System

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Most cited references 52

Diabetes and depression: global perspectives.

Revealing the cost of Type II diabetes in Europe.

The cost of diabetes in Latin America and the Caribbean.

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