Academic journal article Applied Health Economics and Health Policy

Healthcare Costs Associated with Change in Body Mass Index in Patients with Type 2 Diabetes Mellitus in Spain

Academic journal article Applied Health Economics and Health Policy

Healthcare Costs Associated with Change in Body Mass Index in Patients with Type 2 Diabetes Mellitus in Spain

Article excerpt

Key points for decision makers

* In Spanish patients with type 2 diabetes mellitus, increasing BMI was found to be associated with increasing healthcare costs during the study period, and decreasing BMI with decreasing costs, especially in obese patients

* Pharmacy costs were found to be significantly higher in type 2 diabetes patients who gained BMI than in those without a BMI increase


Type 2 diabetes mellitus is one of the leading causes of morbidity and mortality in Europe.[1] Currently, about 285 million people worldwide have diabetes and this number is expected to reach 439 million by 2030.[2] The prevalence of diabetes mellitus in Spain is currently estimated at 8.7%, and type 2 diabetes accounts for about 90% of cases.[3,4] Type 2 diabetes and its complications confer a substantial economic burden on health systems and society that is expected to increase as the prevalence of diabetes increases.[1,5,6] In Spain, during 2002, the total direct medical costs of type 2 diabetes have been estimated at between [euro]2.4 and [euro]2.7 billion, which corresponds to approximately 6.3-7.4% of total public health expenditure.[7] Estimates of the mean type 2 diabetes annual direct costs in Spain are in the range of [euro]1290-[euro]3009 per patient.[7-10]

Patients with type 2 diabetes are at increased risk of cardiovascular disease owing to concomitant presence of cardiovascular risk factors such as obesity, hypertension, dyslipidaemia and tobacco use.[11] Obesity is the most significant risk factor in the development of major complications associated with type 2 diabetes.[12,13] According to a recent estimate, 84% of patients with type 2 diabetes in Spain were either pre-obese, defined by a body mass index (BMI) of >25 kg/m2 and <30 kg/m2 , or obese (BMI ≥30 kg/m2 ),[14] although these estimations would be higher if body composition techniques were considered a diagnostic tool.[15] The prevalence of type 2 diabetes increases with the severity of obesity.[16,17] Together, type 2 diabetes and obesity lead to a higher incidence of diabetes-related complications and cardiovascular events,[18,19] which translates into increased economic costs for national health systems.[1] Likewise, a very recent study in diabetes patients with BMI ≥35 kg/m2 reported that clinical benefits of bariatric surgery translated into considerable economic benefits.[20] Furthermore, diabetes-related complications and/or obesity adversely affect patients' health-related quality of life (HR-QOL),[21-24] primarily in the physical domain. Although studies have assessed the clinical benefit of weight loss in patients with type 2 diabetes,[25-27] little is known about the impact of weight loss or BMI reduction on type 2 diabetes care costs. The objective of the present study was to estimate the effect of BMI change in short-term economic costs of type 2 diabetes care from the Spanish healthcare system perspective.

Materials and Methods

Study Design

The ECOBIM (Economic Impact of BMI on Cost Associated with the Management of Patients with type 2 Diabetes Mellitus) study was an observational, non-interventional, multicentre study conducted in Spain. It consisted of a 12-month observation period (study reference period) for which data were collected retrospectively and cross-sectionally from patients' medical charts at the study visit (figure 1). All data were provided during usual care and no additional visits, tests or interventions were required. The protocol was approved by Hospital Universitario La Paz ethics committee (Madrid, Spain) and conducted in accordance with the Spanish regulation for observational studies and the Declaration of Helsinki. Patients volunteered for the study and authorized the use of their data according to defined provisions in Law 15/1999 of 13 December on the Protection of Personal Data.

Fig. 1 Study design. eCRF = electronic case report form. [Figure omitted.]

Study Population and Investigators

Patients included men and women aged over 30 years who had been diagnosed with type 2 diabetes by the investigator based on the American Diabetes Association (ADA) criteria[4] at least 24 months prior to their inclusion. …

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