Trends in the Management of Type 2 Diabetes and its Prescription Drug Costs in Greece (1998 & 2006)

Abstract

Aims Aim of the present study is to compare control of hyperglycaemia and other diabetes-related cardiovascular risk factors during the years 1998 and 2006 and to estimate the change in the cost of medications prescribed for this purpose.

Methods We compared the medical records of all patients who were regularly followed in three major diabetes centers located in Athens and Piraeus, Greece, during 1998, with those who were examined at the same centers during 2006. The cost of medications was calculated in Euros per patient-year (€PY), using the 2006 official Greek market prices.

Results A total of 1 743 eligible files were included in the study (805 files from 1998 and 938 from 2006). HbA_1c, LDL-cholesterol and blood pressure improved significantly in 2006 as compared to 1998 (7.0% vs. 8.1%, 2.9 mmol/l vs. 3.9 mmol/l and 134.9/77.6 mmHg vs. 139.3/80.9 mmHg respectively, p<0.001 for all comparisons). Treatment of hyperglycaemia was more intense and had a different pattern in 2006. The proportion of patients receiving antihypertensive, hypolipidaemic and antiplatelet drugs increased from 48.8% to 74.4%, from 15.2% to 61.2% and from 17.6% to 51.1% respectively (p<0.001 for all comparisons). A highly significant increase in the cost per patient-year was observed for all classes of medications in 2006. The total cost of all diabetes-related medications increased in 2006 by 221.1% (from 341.3±276.0 €PY to 1095.8±634.1 €PY).

Conclusions Control of cardiovascular risk factors of patients with T2D, regularly followed by diabetes specialists, improved significantly in 2006 as compared to 1998. This improvement, however, was associated with a considerable increase in the cost of medications prescribed for treatment of these parameters

References

• 1 AACE Diabetes Mellitus Clinical Practice Guidelines Task Force . American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus.  Endocr Pract. 2007;  13 ((Suppl 1)) 1-68
• 2 Alexander GC, Sehgal NL, Moloney RM. et al . National trends in treatment of type 2 diabetes mellitus, 1994–2007.  Arch Intern Med. 2008;  168 2088-2094
• 3 Hogan P, Dall T, Nikolov P. American Diabetes Association.  Economic Costs of Diabetes in the U.S.. Diabetes Care. 2003;  26 917-932
• 4 American Diabetes Association . Standards of medical care for patients with diabetes mellitus.  Diabetes Care. 2000;  23 ((Suppl 1)) S32-S42
• 5 American Diabetes Association . Standards of medical care in diabetes-2008.  Diabetes Care. 2008;  31 ((Suppl 1)) S12-S54
• 6 Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010.  Diabet Med. 1997;  14 ((Suppl 5)) S1-S85
• 7 Arnold-Wörner N, Holle R, Rathmann W. et al . The importance of specialist treatment, treatment satisfaction and diabetes education for the compliance of subjects with type 2 diabetes – results from a population-based survey.  Exp Clin Endocrinol Diabetes. 2008;  116 123-128
• 8 Bagust A, Hopkinson PK. et al . An economic model of the long-term health care burden of Type II diabetes.  Diabetologia. 2001;  44 2140-2155
• 9 Colhoun HM, Betteridge DJ, Durrington PN. et al . Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial.  Lancet. 2004;  364 685-696
• 10 Collins R, Armitage J, Parish S. et al . Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial.  Lancet. 2003;  361 2005-2016
• 11 DeWitt DE, Hirsch IB. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: scientific review.  JAMA. 2003;  289 2254-2264
• 12 Ford ES, Li C, Little RR. et al . Trends in A1C concentrations among U.S. adults with diagnosed diabetes from 1999 to 2004.  Diabetes Care. 2008;  31 102-104
• 13 Gaede P, Valentine WJ, Palmer AJ. et al . Cost-effectiveness of intensified versus conventional multifactorial intervention in type 2 diabetes: results and projections from the Steno-2 study.  Diabetes Care. 2008;  31 1510-1515
• 14 Gaede P, Vedel P, Larsen N. et al . Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.  N Engl J Med. 2003;  348 383-393
• 15 Goudswaard AN, Furlong NJ, Rutten GE. et al . Insulin monotherapy versus combinations of insulin with oral hypoglycaemic agents in patients with type 2 diabetes mellitus.  Cochrane Database Syst Rev. 2004;  18 ((4)) CD003418
• 16 Greving JP, Denig P, de Zeeuw D. et al . Trends in hyperlipidemia and hypertension management in type 2 diabetes patients from 1998–2004: a longitudinal observational study.  Cardiovasc Diabetol. 2007;  20 6-25
• 17 Hansson L, Zanchetti A, Carruthers SG. et al . Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group.  Lancet. 1998;  351 1755-1756
• 18 Huppertz E, Pieper L, Klotsche J. et al . Diabetes Mellitus in German Primary Care: quality of glycaemic control and subpopulations not well controlled – results of the DETECT Study.  Exp Clin Endocrinol Diabetes. 2009;  117 6-14
• 19 IDF Clinical Guidelines Task Force . Global Guideline for Type 2 Diabetes: recommendations for standard, comprehensive, and minimal care.  Diabet Med. 2006;  23 579-593 , in 2007. Diabetes Care 2008; 31:591–615
• 20 Klonoff DC, Schwartz DM. An economic analysis of interventions for diabetes.  Diabetes Care. 2000;  23 390-404
• 21 Krentz AJ, Bailey CJ. Oral antidiabetic agents: current role in type 2 diabetes mellitus.  Drugs. 2005;  65 385-411
• 22 Kusnik-Joinville O, Weill A, Salanave B. et al . Prevalence and treatment of diabetes in France: trends between 2000 and 2005.  Diabetes Metab. 2008;  34 266-272
• 23 Lebovitz HE. Oral antidiabetic agents.  Med Clin North Am. 2004;  88 847-863 , ix–x.
• 24 Liatis S. Treatment of diabetes with insulin. In Katsilambros N, Diabetes in Clinical Practice. The Atrium, Southern Gate, Chichester: John Wiley and Sons, Ltd. 2006: 371-408
• 25 Martin S, Schramm W, Schneider B. et al . Epidemiology of complications and total treatment costs from diagnosis of type 2 diabetes in Germany (ROSSO 4).  Exp Clin Endocrinol Diabetes. 2007;  115 495-501
• 26 Rathmann W, Haastert B, Icks A. et al . Trends in outpatient prescription drug costs in diabetic patients in Germany, 1994–2004.  Diabetes Care. 2007;  30 848-853
• 27 Saenz A, Fernandez-Esteban I, Mataix A. et al . Metformin monotherapy for type 2 diabetes mellitus.  Cochrane Database Syst Rev. 2005;  20 ((3)) CD002966
• 28 Schunk M, Schweikert B, Gapp O. et al . Time Trends in Type 2 Diabetes Patients’ Disease Management and Outcomes: Evidence from Two KORA Surveys in Germany.  Exp Clin Endocrinol Diabetes. 2008 Aug 25;  , Epub ahead of print
• 29 Schwarz PE, Lindström J, Kissimova-Scarbeck K. et al . DE-PLAN project. The European perspective of type 2 diabetes prevention: Diabetes in Europe – Prevention using Lifestyle, physical Activity and Nutritional intervention (DE-PLAN) project.  Exp Clin Endocrinol Diabetes. 2008;  116 167-172
• 30 UKPDS Group . Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).  Lancet. 1998;  352 837-853
• 31 UKPDS Group . Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38).  BMJ. 1999;  317 703-713
• 32 UKPDS Group . Cost-effectiveness analysis of improved blood pressure control in hypertensive patients with Type 2 diabetes: UKPDS 40. UK Prospective Diabetes Study Group.  Br Med J. 1998;  317 720-726
• 33 UKPDS Group . Cost-effectiveness of an intensive blood glucose control policy in patients with Type 2 diabetes: economic analysis alongside a randomised controlled trial. UKPDS 41. UK Prospective Diabetes Study Group.  Br Med J. 2000;  320 1373-1378
• 34 von Ferber L, Köster I, Hauner H. Medical costs of diabetic complications total costs and excess costs by age and type of treatment results of the German CoDiM Study.  Exp Clin Endocrinol Diabetes. 2007;  115 97-104
• 35 Yki-Järvinen H. Combination therapies with insulin in type 2 diabetes.  Diabetes Care. 2001;  24 758-767

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