Costs of type 2 diabetes in Germany -: Results of the CODE-2® Study

Background and Objective: Diabetes is an increasing and widespread chronic disease causing considerable costs for the health care system. In the CODE-2(R) Study (Costs of Diabetes in Europe - Type 2) the total expenses for type 2 diabetics in Germany were evaluated and analyzed for the first time. Patients and Methods: The CODE-2(R)-study has been performed in eight European countries. In the German arm of the study, medical, demographic, and economic data of 809 patients were obtained retrospectively for a one year period, using face-to-face interviews with 135 physicians. These results were projected for the overall population of type 2 diabetes patients in Germany. Results: The annual costs caused by type 2 diabetes patients in Germany in 1998 amount to 31.4 billion DM. The majority of these costs (61 %) were covered by statuatory and private health insurance. The annual expenses of the statuatory Health Insurance (SHI) for these patients amounted to 18,5 billion DM. These costs divided in 50% spent for inpatient treatment, 13% for ambulatory care, and 27% for medication. Diabetes medication (Insulin, oral antidiabetic drugs) accounted for only 7% of total SHI costs. Only 26% of all diabetic patients were adjusted to HbA1c values <6,5% according to the therapeutic targets of the European Diabetes policy group. 50% of the type 2 diabetic patients exhibited severe macro- and/or microvascular complications. The costs per patient - compared to the average expenses for SHI insured patients - increased with complication state from the 1.3-fold (no complications) up to the 4.1-fold (macro- and microvascular complications). Conclusions: The overall costs for patients with type 2 diabetes are higher than expected from previous estimates. Diabetes related complications and concomitant diseases are the predominant reasons for these high costs. Control of blood glucose is inadequate for the majority of diabetic patients. To prevent longterm complications, an optimized treatment of type 2 diabetes is imperative not only from a medical but also from a health economics point of view.