Costs of treating type 2 diabetes mellitus and its complications

The major driver of the costs of treating patients with diabetes mellitus type 2 (DM2) is its complications, which in developing countries are a consequence of poor glycemic control due to the low availability of novel, innovative antidiabetic drugs. We aimed to determine the ratio of direct medical costs arising from DM2 to the direct costs of its complications, as well as their main predictors. This was a retrospective cohort study of health care utilization and direct medical costs for adults with DM2, with (inpatients) or without (outpatients) complications. The utilization data were multiplied by the unit prices of drugs and services reimbursed by the Serbian Republic Health Insurance Fund to obtain direct costs. In total, 205 inpatients and 60 outpatients with DM2 participated in the study. Key drivers of the costs of treating diabetes complications in hospitals are consultations with specialist clinicians (B = 0.025 [0.003-0.047]), use of reserve antibiotics (B = 0.022 [0.007-0.036]), biochemical tests (B = 0.038 [0.022-0.055]) and length of stay in the hospital (B = 0.011 [0.009-0.013]). On the other hand, the number of encounters with general practitioners (B = 0.179 0.115-0.242) and the number of ultrasound examinations are strongly correlated with the total costs of treating outpatients with DM2 (B = 0.234 [0.054-0.414]). None of the outpatients included in the study were prescribed novel antidiabetic drugs. Overall, the costs of treating DM2 in Serbia are considerable and mainly driven by the 2-11-fold higher costs of complications vs. the costs of the disease itself.