Impact of type 2 diabetes on health expenditure: estimation based on individual administrative data

Eur J Health Econ. 2019 Jul;20(5):657-668. doi: 10.1007/s10198-018-1024-9. Epub 2019 Jan 5.

Abstract

Only limited data are available in France on the incidence and health expenditure of type 2 diabetes. The objective of this study, based on national health insurance administrative database, is to describe the expenditure reimbursed to patients newly treated for type 2 diabetes and the proportion of expenditure attributable to diabetes. The study is conducted over a 6-year period from 2008, the year of incidence of treated diabetes, to 2014. Type 2 diabetic patients aged 45 years and older are identified on the basis of their drug consumption. To estimate expenditure attributable to diabetes, a matched control group is selected among more than 13 million beneficiaries over 44 years old not taking antidiabetic treatment. The expenditure attributable to diabetes is estimated by two methods: simple comparison of reimbursed health expenditure between both groups, and a difference-in-differences method including control variables. The cohort of incident type 2 diabetic patients comprises 170,013 patients in 2008. Mean global reimbursed expenditure is €4700 per patient in 2008 and €5500 in 2015. Expenditure attributable to diabetes, estimated by direct comparison with controls, is €1500 in the first year. We, thus, observe a decrease in the following year due to decreased hospitalisations, and then expenditure increase by an average of 7% per year to reach €1900 in the eighth year after the initiation of treatment.

Keywords: Cost of illness; Difference in differences; Exact matching; France; SNDS; Type 2 diabetes.

MeSH terms

  • Aged
  • Databases, Factual
  • Diabetes Mellitus, Type 2 / economics*
  • Female
  • France
  • Health Expenditures / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • National Health Programs