Abstract
Objective: To review studies on the costs of diabetes and its complications through a scheme designed specifically for assessing the quality of cost-of-illness (COI) studies.
Design and Setting: The methodology of COI studies in diabetes was analysed in order to assess the significance of quantitative results. The scheme adopted 7 items identified as the main points for discussing the methodological choices governing the results. We also used a checklist based on questions related to the 7 items.
Main outcome measures and results: The answers showed that many studies appear not to give technical details, so it is hard to understand themethod.Methodological choices varied widely between the studies. This is probably due to the lack of consensus on the methodology of COI studies. Based on the findings of this review, we suggest also some specific points that could help produce more reliable results on the costs of diabetes.
Conclusions: Clearly, a general consensus on COI studies is still remote, making the value of any comparison of results questionable.
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References
Jefferson T, Demicheli V, Mugford M. Elementary economic evaluation in health care. London: BMJ Publishing Group, 1996
Zimmet P, McCarty D. The NIDDM epidemic: global estimates and projections; a look into the crystal ball. IDF Bull 1995; 40 (3): 8–16
World Health Organization (WHO). Prevention of diabetes mellitus. Geneva: WHO, 1994. Technical report series no.: 844
Alexander WD, South East Thames Diabetes Physicians Group. Diabetes care in a UK health region: activity, facilities and costs. Diabet Med 1988; 5: 577–581
Bransom ED. Financing the care of diabetesmellitus in the U.S. Diabetes Care 1992; 15 Suppl. 1: 1–5
Bransome ED. Improving the financing of diabetes care in the 1990s. Diabetes Care 1992; 15 Suppl. 1: 66–72
Casparie AF, van der Waal MAE. Differences in preferences between diabetic patients and diabetologists regarding quality of care: a matter of continuity and efficiency of care? Diabet Med 1995; 12: 828–32
Currie CJ, Williams DRR, Peters JR. Patterns of in and out-patient activity for diabetes: a district survey. Diabet Med 1996; 13: 273–80
Damsgaard EM, Froland A, Green A. Use of hospital services by elderly diabetics: the Frederica study of diabetic and fasting hyperglycaemic patients aged 60-74 years. Diabet Med 1987; 4: 317–22
Gagliardino JJ, Olivera EM, Barragàn, et al. A simple economic evaluation model for selecting diabetes health care strategies. Diabet Med 1993; 10: 351–4
Geffner DL. Diabetes care in health maintenance organizations. Diabetes Care 1992; 15 Suppl. 1: 44–50
Glasgow RE. A practical model of diabetes management and education. Diabetes Care 1995; 18 (1): 117–26
Korn AM. Case management and quality of care for diabetic patients. Diabetes Care 1992; 15 Suppl. 1: 59–61
Leese B. Diabetes mellitus and the St Vincent declaration: the economic implications. Pharmacoeconomics 1995; 7 (4): 292–307
McGill M. Diabetes ambulatory care: its impact in the approach and cost of treating people with diabetes. IDF Bull 1995; 40 (4): 29–35
Olsson J, Persson U, Tollin C, et al. Comparison of excess costs of care and production losses because of morbidity in diabetic patients. Diabetes Care 1994; 17 (11): 1257–63
The Diabetes Control and Complications Trial Research Group. Lifetime benefits and costs of intensive therapy as practiced in the diabetes control and complications trial. JAMA 1996; 276 (17): 1409–15
The Diabetes Control and Complications Trial Research Group. Resource utilization and costs of care in the diabetes control and complications trial. Diabetes Care 1995; 18 (11): 1468–78
Drummond MF, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford Medical Publications, 1987
Drummond MF, Davies LM, Ferris FL. Assessing the costs and benefits of medical research: the diabetic retinopathy study. Soc Sci Med 1992; 34 (9): 973–81
Dasbach EJ, Fryback DG, Newcomb PA, et al. Cost-effectiveness of strategies for detecting diabetic retinopathy. Med Care 1991; 29 (1): 20–39
Frendrick A, Javitt JC and Chiang YP. Cost effectiveness of the screening and treatment of diabetic retinopathy: what are the costs of underutilization? Int J Technol Assess Health Care 1992; 8: 694–707
Javitt JC, Aiello LP. Cost effectiveness of detecting and treating diabetic retinopathy. Ann Intern Med 1996; 124: 164–9
Javitt JC, Canner JK, Sommer A. Cost effectiveness of current approaches to the control of retinopathy in type 1 diabetics. Ophthalmology 1989; 96 (2): 255–64
Lairson DR, Pugh JA, Kapadia AS, et al. Cost effectiveness of alternative methods for diabetic retinopathy screening. Diabetes Care 1992; 15: 1369–77
Savolainen EA, Lee QP. Diabetic retinopathy. Need and demand for photocoagulation and its cost effectiveness: evaluation based on services in the UK. Diabetologia 1982; 23: 138–40
Schulper MJ, Buxton MJ, Ferguson BA, et al. A relative cost effectiveness analysis of different methods of screening for diabetic retinopathy. Diabet Med 1991; 8: 644–50
Schulper MJ, Buxton MJ, Ferguson BA, et al. Screening for diabetic retinopathy: a relative cost effectiveness analysis of altrenative modalities and strategies. Health Econ 1992; 1: 39–51
Vondeling H. Evaluation of argon laser treatment of diabetic retinopathy and its diffusion in theNetherlands. Health Policy 1993; 23: 97–111
Garattini L, Brunetti M, Salvioni F, et al. Economic evaluation of ACE inhibitor treatment of nephropathy in patients with insulin-dependent diabetes mellitus in Italy. Pharmacoeconomics 1997; 12 (1): 67–75
Borch-Johnsen K, Wentzel H, Viberti GC, et al. Is screening and intervention for microalbuminuria worthwhile in patients with insulin dependent diabetes. BMJ 1993; 306: 1722–5
Kiber BA, Jindal KK. Screening to prevent renal failure in insulin dependent diabetic patients: an economic evaluation. BMJ 1995; 311: 1595–9
Le Floch JP, Charles MA, Philippon C, et al. Cost effectiveness of screening for microalbuminuria using immunochemical dipstick tests or laboratory assays in diabetic patients. Diabet Med 1994; 11: 349–56
Rodby RA, Lewis EJ, Firth LM. An economic analysis of ET in the treatment of diabetic nephropathy. Diabetes Care 1996; 19 (10): 1051–61
Siegel JE, Krolewski AS, Warram JH, et al. Cost effectiveness of screening and early treatment of nephropathy in patients with IDDM. J Am Soc Nephrol 1992; 3: 3111–9
Eckman MH, Greenfield S, Mackey WC, et al. Foot infections in diabetic patients: decision and cost-effectiveness analysis. JAMA 1995; 237 (9): 712–20
Benton GS, Kerstein MD. Cost effectiveness of early digit amputation in the patient with diabetes. Surg Gynecol Obstet 1985; 161: 523–4
Songer T. The economic costs of NIDDM. Diabetes Metab Rev 1992; 8 (4): 389–404
Drummond M. Cost-of-illness studies: a major headache? Pharmacoeconomics 1992; 2 (1): 1–4
Mooney G. Key issues in health economics. London: Harvester Wheatsheaf, 1994
Davey PJ, Leeder SR. The cost of migraine: more than just a headache? Pharmacoeconomics 1992; 2 (1): 5–7
Simell TT, Sintonen H, Hahl J, et al. Costs of insulin dependent diabetes mellitus. Pharmacoeconomics 1996; 9 (1): 24–38
Rice DP. Cost of illness studies: fact or fiction? Lancet 1994; 344: 1519–20
McMaster Health Sciences Centre. How to read clinical journals. VII: to understand an economic evaluation (parts A and B). Can Med Assoc J 1984; 130: 1156–434
Gerard K. Cost-utility in practice: a policy maker’s guide to the state of the art. Health Policy 1992, 21: 249–79
Australian Commonwealth Department of Human Services and Health. Guidelines for the pharmaceutical industry on preparation of submissions to the Pharmaceutical Benefits Advisory Committee. Canberra: Australian Governement Publishing Service, 1995
Canadian Coordinating Office on Health Tecnology Assessment (CCOHTA): Guidelines for economic evaluations of pharmaceutical: Canada. 1st ed. Ottawa (ON): CCOHTA, 1994
Ontario Ministry of Health. Ontario guidelines for economic analysis of pharmaceutical products. Toronto (ON): Ontario Ministry of Health, 1994
England and Wales Department of Health. Guidelines on good practice in the conduct of economic evaluation of medicines. London: Department of Health, 1994
Ament A, Evers S. Cost of illness studies in health care: a comparison of two cases. Health Policy 1993; 26: 29–42
Sheldon T. Problems of using modelling in the economic evaluation of health care. Health Econ 1996; 5: 1–11
Buxton M, Drummond MF, Van Hout BA, et al. Modelling in economic evaluation: an unavoidable fact of life. Health Econ 1997; 6: 217–27
Drummond MF, O’Brien BJ, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press, 1997
Blumenschein K, Johannesson M. Economic evaluation in healthcare. Pharmacoeconomics 1996; 10 (2): 114–22
Koopmanschap MA, Rutten FFH. Indirect costs in economic studies: confronting the confusion. Pharmacoeconomics 1993; 4 (6): 446–54
Koopmanschap MA, Rutten FFH. A practical guide for calculating indirect costs of disease. Pharmacoeconomics 1996; 10 (5): 460–6
Rice DP. Estimating the cost of illness. Health economic series No.6: public health service. Washington, DC: US Government Printing Office, 1966
Tediosi F, Pagano E, Garattini L. Costi della schizofrenia: un’-analisi metodologica della letteratura esistente. Soc Ital Psichiatria: Boll Sci Inform 1998; Anno V, Marzo.-Luglio: 41–7
Tolpin HG, Bentkover JD. Economic costs of illness: decision making applications and practical considerations. In: Scheffler R, Rossiter L, editors. Advances in health economic and health services resources. Greenwich (CT): JAI Press, 1983
Bootman JL, Townsend RJ, McGhan WF. Principles of pharmacoeconomics. Cincinnati (OH): Harvey Whitney Books Company, 1991
Weisbrod B. Economics of public health. Philadelphia (PA): University of Pennsylvania Press, 1961
Cooper BS, Rice DP. The economic cost of illness revisited. Soc Security Bull 1976; 39: 21–36
Koopmanschap MA, Rutten FFH, van Ineveld MB, et al. The friction cost method for measuring indirect costs of disease. Health Econ 1995; 14: 171–89
Agro KE, Bradley CA, Mittmann N, et al. Sensitivity analysis in health economic and pharmacoeconomic studies. Pharmacoeconomics 1997; 11 (1): 75–88
Leese B. The cost of diabetes and its complications: a review. Centre for health economics. York: University of York, 1991
Jönsson B. Diabetes-the cost of illness and the cost of control. Acta Med Scand Suppl 1983; 671: 19–27
Gerard K, Donaldson C, Maynard AK. The cost of diabetes. Diabet Med 1989; 6: 164–70
American Diabetes Association (ADA). Direct and indirect costs of diabetes in the United States, 1992. Alexandria: ADA Inc., 1993
Rubin RJ, Altman WM, Mendelson DN. Health care expenditures for people with diabetes mellitus in 1992. J Clin Endocrinol Metab 1994; 78 (4): 809A–F
Phillips M, Salmeron J. Diabetes inMexico: a serious and growing problem. World Health Stat Q 1992; 45: 338–46
Kegler MC, Lengerich EJ, Norman M, et al. The burden of diabetes in North Carolina. North Carolina Med J 1995; 56: 141–4
Warner DC, McCandless RR, De Nino LA, et al. Costs of diabetes in Texas, 1992. Diabetes Care 1996; 19 (12): 1416–9
Kangas T, Aro S, Koivisto VA, et al. Structure and costs of health care of diabetic patients in Finland. Diabetes Care 1993; 19 (5): 494–7
McKendry JBR. Direct costs of diabetes care: a survey in Ottawa, Ontario 1986. Can J Public Health 1989; 80: 124–8
Triomphe A, Flori YA, Costagliola D, et al. The cost of diabetes in France. Health Policy 1988; 9: 39–48
Chale SS, Swai ABM, Mujinja PGM, et al. Must diabetes be a fatal disease in Africa? Study of costs of treatment. BMJ 1992; 304: 1215–8
Gray A, Fenn P, McGuire A. The cost of insulin-dependent diabetes mellitus (IDDM) in England andWales. Diabet Med 1995; 12: 1068–76
Stern Z, Levy R. The direct cost of type 1 diabetes mellitus in Israel. Diabet Med 1994; 11: 528–33
Huse DM, Oster G, Killen AR, et al. The economic costs of non-insulin-dependent diabetes mellitus. JAMA 1989; 262 (19): 2708–13
Hart WM, Espinosa C, Rovira J. Asimulation model of the cost of the incidence of IDDM in Spain. Diabetologia 1997; 40: 312–8
Maynard A. Economic evaluation techniques in healthcare: reinventing the wheel? Pharmacoeconomics 1997; 11 (2): 115–8
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Pagano, E., Brunetti, M., Tediosi, F. et al. Costs of Diabetes. Pharmacoeconomics 15, 583–595 (1999). https://doi.org/10.2165/00019053-199915060-00006
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DOI: https://doi.org/10.2165/00019053-199915060-00006