Reduction of direct and indirect costs of treatment of patients with type 2 diabetes due to good glycemic control and reduced frequency of complications

Abstract

Introduction: Patients with type 2 diabetes represent a large burden on healthcare systems primarily due to the multidisciplinary treatment of complications. Good glycemic control is associated with a reduced incidence of complications. Objective: The aim of this paper is to estimate the absolute amount of reduction in costs of type 2 diabetes treatment due to better glycemic control and reduction in the frequency of complications in an upper-middle income country, such as Serbia. Method: The research was designed as a study of costs emerging from complications of type 2 diabetes, and specifically the impact of lowering glycosylated hemoglobin on cost reduction due to changes in complication rates. Direct and indirect costs were taken into account from the perspective of the Republic Health Insurance Fund (RHIF) and private health insurance, i.e. patients themselves as direct payers of services. The time horizon is one year. All cost calculations were performed using a mathematical model, with simulation on a cohort of 1.000 virtual patients and data input in the form of inverse probability distributions. Results: The results of our study indicate that good glycemic control due to the optimal use of antidiabetic drugs leads to a significant reduction in the frequency of complications and treatment costs. Reduction of glycosylated hemoglobin by only 1% reduces direct treatment costs by about 8.300 RSD per year per patient with diabetes from the perspective of the RHIF, and by about 52.500 RSD from the perspective of the patient as a direct payer of services or that of private (supplementary) health insurance; if both perspectives are taken into account at the same time (60:40 payment ratio RHIF/private insurance), the annual saving is about 26.000 RSD per patient. Reduction of indirect costs due to reduction of glycosylated hemoglobin and reduced absenteeism per patient on an annual basis is about 24.000 RSD. Conclusion: Good glycemic control in patients with type 2 diabetes in the Republic of Serbia brings significant savings on an annual basis due to a reduced frequency of complications. These savings open up space to increase the availability of innovative antidiabetic drugs for a significantly wider range of patients with type 2 diabetes, without the restrictions that currently exist, primarily in terms of body weight.