ROSSO 2 – Diabetes Economics

What threat is diabetes imposing on today’s societies?

Diabetes is the fifth leading cause of death by disease in the U.S. Diabetes also contributes to higher rates of morbidity. In the U.S., the direct and indirect expenditures attributable to diabetes in 2002 were estimated at $132 billion. More than $1 in $10 spent on health care services in the U.S. is attributable to diabetes.

In Germany the annual costs of treating diabetes mellitus and its late complications is € 3.196 per patient. Depending on the prevalence assumed for the disease in Germany, this corresponds to between 4.6% and 8.2% of German healthcare spending. Generally speaking, the immediate and long-term costs of diabetes complications are considerable and placing a major threat in almost all societies.

What can people and societies do to cope with this challenge?

Diabetes is associated with a range of late complications and these complications drive the costs as figure 1 illustrates. The DCCT and other studies documented that better control reduces the risk of complications. Even more important, a frequent self-monitoring of blood glucose levels was associated with clinically and statistically better glycemic control regardless of diabetes type or therapy.

What are the economical benefits that are associated with SMBG?

The clinical evidence on above issue has not always been straightforward. Today, however, the ROSSO-study showed that the number of non-fatal and fatal events was significantly lower in the SMBG group compared with the non-SMBG group. The study demonstrated 32% lower morbidity and 51% lower mortality in people using SMBG, compared with those who did not. In addition, ROSSO documented that SMBG results in a significant cost reduction as shown in the graph below. With these fascinating findings there is a strong argument to claim a better coverage for type 2 patients (next to type 1 diabetics). In times of limited resources top priority must be given to preventing diabetes or at least to preventing diabetes-induced complications by means of optimal diabetes therapy including better SMBG.

SBGM is seen as a cost-effective means of achieving this aim. In the Gulf countries many patients report some level of SMBG monitoring. But most say they practice less than recommended by the local physician. The lower frequency of SMBG among subjects paying higher out-of-pocket expenditures for strips suggests that removal of financial barriers by providing more comprehensive coverage for these costs may optimize the frequency of SMBG. Even more important, better coverage (=reimbursement) results in a substantial improvement of the glycemic control and consequently in less complications.