Abstract
Aims:
Recently, medical expenditures were found to be 2-fold increased in paediatric patients
with diabetic ketoacidotic events (DKA) in the U.S., in particular due to hospitalization.
Aim of our study was to analyse DKAs and associated costs in Germany, where structured
diabetes care including education is available for all patients.
Methods:
For all 12 001 diabetic patients 0–19 years of age (52.6% male, mean age (SD) 12.6
(3.9) years) documented in a German-wide database, all DKAs were assessed, as well
as costs for diabetes-related treatment. Associations between costs and DKA were estimated
using log-linear models.
Results:
457 (3.8%) patients had at least 1 DKA during 2007. Total annual costs for patients
without, with 1, or ≥ 2 DKAs were € 3 330 (95%-CI 3 292–3 368), € 6 935 (CI 6 627–7 244),
and € 10 728 (CI 9 813–11 644), respectively, with largest differences for hospitalization
costs (€ 693, € 4 145, € 8 092). Age-sex-diabetes duration-adjusted cost ratios for
patients with 1, or ≥ 2 DKAs compared to patients without DKA were 2.2 (CI 2.1–2.3)
and 3.6 (CI 3.1–4.1), respectively.
Conclusions:
In Germany, paediatric diabetic patients with DKA had up to 3.6-fold higher diabetes-related
costs compared to those without DKA. This cost excess was higher compared to a U.S.
study, however, the proportion of patients with DKA was much lower (3.8% versus 14.9%).
The lower frequency of DKA in Germany may be due to a higher access to and utilization
of diabetes education. Interventions should reduce DKA and resulting hospital admission
in pediatric patients in order to reduce costs and improve quality of life.
Key words
type 1 paediatric diabetes - diabetic ketoacidosis - costs
