Background
Methods
Study design and data source
Observation period
Patient selection and classification
Estimation of yearly reimbursed expenditures
Statistical analysis
Results
Year | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Diabetics patients followed up (1)
|
19,005
|
20,434
|
21,512
|
22,566
|
23,713
|
24,862
| ||||||
Patients analyzed
|
9,682
|
10,397
|
11,094
|
11,772
|
11,583
|
9,734
| ||||||
Monotherapy | 5,792 | 59.8% | 5,890 | 56.7% | 6,080 | 54.8% | 6,390 | 54.3% | 6,065 | 52.4% | 4,764 | |
Double therapy | 2,484 | 25.7% | 2,815 | 27.1% | 3,029 | 27.3% | 3,147 | 26.7% | 3,100 | 26.8% | 2,770 | 28.5% |
Triple therapy | 355 | 3.7% | 447 | 4.3% | 551 | 5.0% | 657 | 5.6% | 730 | 6.3% | 803 | 8.2% |
Polytherapy | 14 | 0.1% | 28 | 0.3% | 44 | 0.4% | 66 | 0.6% | 73 | 0.6% | 98 | 1.0% |
Insulinotherapy | 1,037 | 10.7% | 1,217 | 11.7% | 1,390 | 12.5% | 1,512 | 12.8% | 1,615 | 13.9% | 1,299 | 13.3% |
Patients excluded
|
9,323
|
10,037
|
10,418
|
10,794
|
12,130
|
15,128
| ||||||
Lost to follow up | 4,562 | 49% | 4,877 | 49% | 4,909 | 47% | 4,821 | 45% | 4,923 | 41% | 4,418 | 29% |
No pharmacological treatment | 839 | 9% | 1,152 | 11% | 1,466 | 14% | 1,719 | 16% | 2,008 | 17% | 1,610 | 11% |
Pharmacological treatment with:
| ||||||||||||
Discontinuation period | 1,692 | 18% | 1,846 | 18% | 1,907 | 18% | 1,959 | 18% | 2,535 | 21% | 6,411 | 42% |
Non stationary period | 1,255 | 13% | 1,070 | 11% | 1,086 | 10% | 1,225 | 11% | 1,432 | 12% | 1,978 | 13% |
Stage changes | 975 | 10% | 1,092 | 11% | 1,050 | 10% | 1,070 | 10% | 1,232 | 10% | 711 | 5% |
Diabetic patients | 25,458 | ||
---|---|---|---|
2 Measurements of creatinine clearance and 2 Measurements of urinary protein within a one-year time frame | 2,109 | 8,3% | |
OR | At least one record associated with a long term condition “chronic nephropathy and primitive nephrotic syndrom” and at least one ICD 10 code related to chronic kidney failure | 127 | 0,5% |
OR | At least one prescription dispensing of treatment from the following list associated to a nephrologist visit: ACE-I (Angiotensin converting enzyme inhibitors) and A2RA (Angiotensin II receptor antagonists) in association, phosphorus chelators (*), polystyrene sulfonate (**), Angiotensin converting enzyme (ACE) inhibitors, | 496 | 1,9% |
OR | At least two dispensings with an interval from 30 to 365 days of a conbination of following treatment: ACE-I, A2RA, phosphorus chelators (*), polystyrene sulfonate (**) | 170 | 0,7% |
Total number of patients with a chronic kidney failure (CKF) (Declining Renal Function)
|
2,535
|
10,0%
| |
Patients with terminal CKF: patients with a CKF and…:
| |||
At least 2 records associated with a CCAM code related to dialyse within a One-week time period | 67 | 0,3% | |
OR | At least 2 prescription dispensings of erythropoietin AND 2 prescriptions dispensing of phosphorus chelators within a 45 days-time period | 22 | 0,1% |
Total number of patients with a terminal CKF
|
80
| 0,3% | |
Patients with severe CKF: patients with a CKF…
|
585
| 2,3% | |
At least 2 prescription dispensings of erythropoietin | 470 | 1,8% | |
OR | At least 2 prescription dispensings of phosphorus chelators | 140 | 0,5% |
OR | At least 4 nephrologist visits within 12-months time frame | 58 | 0,2% |
Total number of patients with a severe CKF
|
585
| 2,3% | |
Patients with moderate CKF: Patients with a CKF not defined as severe or terminal
| |||
Total number of patients with moderate CKF
|
1,870
| 7,3% |
Patients with normal renal function | Patients with declining renal function | ||||||||
---|---|---|---|---|---|---|---|---|---|
Mono-therapy | Double therapy | Triple therapy | Insulin therapy | Non diabetic patients | Mono-therapy | Double therapy | Triple therapy | Insulin therapy | |
Number of patients | 4,353 | 2,503 | 728 | 1,032 | 27,389 | 411 | 267 | 78 | 267 |
Female (N,%) | 48.0% | 46.1% | 43.4% | 53.7% | 47.6% | 45.3% | 44.9% | 35.9% | 47.2% |
Age (mean, sd) (1) | 67.7 (11.5) | 66.3 (11.1) | 64.0 (10.1) | 67.4 (11.9) | 66.9(11.4) | 69.6 (11.0) | 67.3 (11.6) | 66.0 (10.3) | 71.4 (10.0) |
Out of metropolitan France | 4.5% | 5.3% | 5.9% | 8.6% | - | 6.6% | 9.4% | 7.7% | 10.1% |
CMU* beneficiary | 2.5% | 3.4% | 4.3% | 3.3% | 3.3% | 4.9% | 6.0% | 3.9% | 3.0% |
Reimbursement rate for antidiabetics (mean, sd) | 90.9 (15.6) | 95.7 (12.0) | 97.2 (10.3) | 98.1 (8.1) | - | - | - | - | - |
Antihypertensive | 79.0% | 79.0% | 81.2% | 86,0% | 47.8% | 88.3% | 85.8% | 93.6% | 96.3% |
Antithrombotic agents | 41.3% | 41.9% | 40.3% | 60.3% | 22.7% | 49.4% | 44.9% | 32.1% | 74.5% |
Hypolipidemic drugs | 62.8% | 65.0% | 72.1% | 69.0% | 33.0% | 67.4% | 67.8% | 71.8% | 79.8% |
ALD*-5: Cardiac Insufficiency | 2.8% | 1.8% | 1.7% | 2.4% | 1.7% | 4.4% | 2.3% | 2.6% | 1.9% |
ALD-8: Diabetes | 32.9% | 50.1% | 62.9% | 75.6% | - | 41.6% | 56.6% | 73.1% | 77.9% |
ALD-12: Hypertension | 10.9% | 9.8% | 9.9% | 10.2% | 3.0% | 13.1% | 18.0% | 14.1% | 12.0% |
ALD-13: Myocardial infarction | 5.7% | 5.1% | 3.7% | 5.6% | 3.7% | 7.5% | 3.8% | 1.3% | 7.1% |
ALD-23: Psychosis | 4.0% | 4.0% | 5.5% | 6.5% | 3.5% | 2.9% | 3.8% | 2.6% | 4.5% |
ALD-30: Malignant cancer | 5.8% | 5.0% | 3.2% | 3.5% | 5.5% | 7.1% | 6.7% | 2.6% | 5.6% |
Ambulatory care expenditures over time
2005 | 2006 | 2007 | 2008 | 2009 | 2010 | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N | Mean | SD | N | Mean | SD | N | Mean | SD | N | Mean | SD | N | Mean | SD | N | Mean | SD | |
Patients with Normal Renal Function
| ||||||||||||||||||
Monotherapy
|
5,507
| 2,703 | 3,333 | 5,543 | 2,711 | 3,407 | 5,682 | 2,821 | 3,542 | 5,921 | 2,971 | 3,916 | 5,538 | 2,980 | 3,876 | 4,353 | 3,017 | 3,829 |
Double therapy
| 2,324 | 2,884 | 3,113 | 2,587 | 2,935 | 3,206 | 2,762 | 3,095 | 3,622 | 2,839 | 3,125 | 3,611 | 2,786 | 3,171 | 3,861 | 2,503 | 3,308 | 4,045 |
Triple therapy
| 328 | 3,473 | 3,121 | 406 | 3,295 | 3,013 | 505 | 3,313 | 2,938 | 587 | 3,180 | 3,011 | 658 | 3,264 | 3,312 | 728 | 3,609 | 3,801 |
Insulin therapy
|
898
| 6,759 | 5,203 | 1,029 | 6,800 | 5,192 | 1,150 | 7,063 | 5,573 | 1,214 | 7,058 | 5,903 | 1,256 | 7,228 | 5,658 | 1,032 | 7,398 | 5,487 |
Non diabetic patients
|
27,389
|
1,715
|
2,914
|
28,962
|
1,767
|
3,060
|
30,618
|
1,866
|
3,261
|
32,103
|
1,994
|
3,475
|
31,128
|
2,150
|
3,979
|
26,253
|
2,166
| 4,102 |
Patients with Declining Renal Function
| ||||||||||||||||||
Monotherapy
|
282
| 4,148 | 4,258 |
339
| 4,267 | 4,426 |
393
| 4,396 | 4,811 |
465
| 4,897 | 6,427 |
518
| 4,149 | 4,637 |
411
| 4,226 | 5,369 |
Double therapy
|
157
| 3,773 | 3,144 |
228
| 3,603 | 3,628 |
266
| 3,667 | 3,257 |
308
| 3,892 | 4,004 |
310
| 3,891 | 4,623 |
267
| 4,159 | 5,268 |
Triple therapy
|
27
| 4,244 | 3,641 |
41
| 3,105 | 1,617 |
45
| 4,052 | 3,396 |
69
| 4,203 | 4,411 |
71
| 3,387 | 3,027 |
78
| 4,032 | 4,329 |
Insulin therapy
|
136
| 10,772 | 9,335 |
188
| 10,227 | 8,882 |
240
| 10,644 | 10,731 |
294
| 10,499 | 10,185 |
359
| 11,155 | 11,188 |
267
| 11,344 | 11,185 |
Individual ambulatory care expenditures in 2010
Consultations visits | Physio-therapist | Nursing care | Biological diagnostic tests | Radiology/medical imaging | Medical devices | Transportation | Invalidity | Pharmacy | Others | Total ambulatory care costs | |
---|---|---|---|---|---|---|---|---|---|---|---|
Monotherapy (mono): m (σ) | 256 (190) | 90 (339) | 144 (853) | 159 (175) | 113 (191) | 272 (861) | 88 (449) | 219 (1,451) | 1,156 (1,786) | 521 (1,528) | 3,017 (3,829) |
Double therapy (bi): m (σ) | 257 (156) | 88 (372) | 152(885) | 155 (158) | 107 (186) | 294 (728) | 98 (787) | 240 (1,730) | 1,411 (1,650) | 506 (1,679) | 3,308 (4,045) |
Cost ratio vs mono |
1.045
|
0.909
|
1.392
|
1.070
|
0.940
|
1.237
|
1.113
|
0.976
|
1.236
|
0.885
|
1.102
|
Triple therapy (tri): m (σ) | 252 (146) | 55(280) | 94 (646) | 149 (129) | 110 (188) | 272 (410) | 112 (707) | 308 (1,857) | 1,798 (1,509) | 460 (1,337) | 3,609(3,801) |
Cost ratio vs bi |
1.044
|
0.728
|
0.675
|
0.977
|
1.038
|
1.059
|
1.022
|
1.026
|
1.287
|
0.926
|
1.101
|
Insulin therapy: m (σ) | 329 (208) | 157 (499) | 1,586 (2761) | 198 (210) | 140 (221) | 1,216 (1,697) | 264 (1,064) | 444 (2,025) | 2,646 (2,124) | 420 (1,093) | 7,398(5,487) |
Cost ratio vs tri |
1.200
|
2.509
|
18.420
|
1.189
|
1.178
|
3.931
|
2.480
|
2.929
|
1.331
|
1.228
|
1.942
|
Non diabetic patients
| 175 (184) | 81 (324) | 101 (977) | 93 (176) | 95 (170) | 160 (805) | 85 (582) | 136 (1,131) | 702 (2,142) | 538 (1,799) | 2,166 (4,102) |
Additional costs vs non diabetic patients: € (increase rate in %)
| |||||||||||
Monotherapy | 80 (46.3%) | 9 (11.1%) | 43 (42.6%) | 66 (71.0%) | 18 (18.9%) | 112 (70.0%) | 3 (3.5%) | 83 (61.0%) | 454 (64.7%) | −17 (-3.2%) | 852 (39.3%) |
Double therapy | 81 (46.9%) | 7 (8.6%) | 51 (50.5%) | 62 (66.7%) | 12 (12.6%) | 134 (83.8%) | 13 (15.3%) | 104 (76.5%) | 709 (101.0%) | −32 (-5.9%) | 1,142 (52.7%) |
Triple therapy | 77 (44.0%) | −26 (-32.1%) | −7 (-6.9%) | 56 (60.2%) | 15 (15.8%) | 112 (70.0%) | 27 (31.8%) | 172 (126.5%) | 1,096 (156.1%) | −78 (-14.5%) | 1,444 (66.7%) |
Insulin therapy | 154 (88.0%) | 76 (93.8%) | 1,485 (1,470.3%) | 105 (112.9%) | 45 (47.4%) | 1,056 (660.0%) | 179 (210.6%) | 308 (226.5%) | 1,944 (276.9%) | −118 (-21.9%) | 5,234 (241.7%) |
Treatment phases (ref = monotherapy) | Pharmacy | Consultations | Medical devices | Nursing cares | Others | Total ambulatory costs |
---|---|---|---|---|---|---|
Double therapy
| 238*** | 9*** | 26*** | 9 | −31 | 224*** |
(213;262) | (6;12) | (15;38) | (-5;23) | (-71;9) | (169;280) | |
Triple therapy
| 556*** | 16*** | 35** | −30* | −131*** | 411*** |
(509;603) | (11;21) | (13;57) | (-56;-4) | (-208;-55) | (306;517) | |
Insulin therapy
| 1,224*** | 78*** | 863*** | 1,236*** | 1,268*** | 3,807*** |
(1,190;1,259) | (74;82) | (847;880) | (1,217;1,256) | (1,212;1,325) | (3,730;3,885) |
Mono therapy | Double therapy | Triple therapy | Insulin therapy | Non diabetics | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | |
A-Alimentary tract and metabolism
| ||||||||||
Insulin
| €4 | (€37) | €10 | (€55) | €12 | (€63) | €881 | (€516) | €3 | (€54) |
Oral antidiabetic agents
| €129 | (€114) | €367 | (€201) | €647 | (€244) | €147 | (€196) | - | - |
GLP-1 Analog
| €3 | (€50) | €13 | (€121) | €94 | (€319) | €32 | (€185) | - | - |
Other alimentary tract and metabolism products
| €75 | (€136) | €64 | (€111) | €64 | (€116) | €121 | (€174) | €55 | (€125) |
B-Blood and blood forming organs
| ||||||||||
Antithrombotic agents
| €61 | (€154) | €69 | (€172) | €61 | (€170) | €127 | (€291) | €34 | (€120) |
Antihemorrhagics
| €0 | (€1) | €1 | (€68) | €0 | (€0) | €0 | (€3) | €0 | (€55) |
Antianemic preparations
| €18 | (€396) | €18 | (€287) | €7 | (€106) | €46 | (€670) | €12 | (€296) |
Blood substitutes and perfusion solutions
| €1 | (€15) | €0 | (€2) | €0 | (€3) | €1 | (€7) | €2 | (€70) |
C- Cardiovascular system
| ||||||||||
Cardiac therapy
| €24 | (€87) | €20 | (€72) | €15 | (€52) | €43 | (€120) | €14 | (€57) |
Antihypertensive
| €10 | (€49) | €13 | (€55) | €15 | (€61) | €19 | (€65) | €4 | (€27) |
Diuretics
| €14 | (€52) | €12 | (€37) | €11 | (€66) | €24 | (€77) | €6 | (€34) |
Beta-blocking agents
| €33 | (€62) | €33 | (€60) | €33 | (€58) | €43 | (€76) | €15 | (€40) |
Calcium channel blockers
| €31 | (€65) | €33 | (€66) | €32 | (€67) | €40 | (€72) | €14 | (€43) |
Agents acting of the renin-angiotensin system
| €152 | (€147) | €171 | (€155) | €196 | (€160) | €207 | (€163) | €61 | (€105) |
Lipid modifying agents – Statins
| €127 | (€162) | €146 | (€179) | €177 | (€185) | €190 | (€201) | €52 | (€113) |
Lipid modifying agents - Other
| €19 | (€76) | €19 | (€81) | €20 | (€89) | €24 | (€109) | €10 | (€53) |
Other cardiovascular system drugs
| €4 | (€23) | €4 | (€24) | €5 | (€30) | €8 | (€36) | €2 | (€17) |
D-Dermatologicals
| €10 | (€40) | €11 | (€43) | €13 | (€61) | €18 | (€61) | €7 | (€32) |
G-Genito urinary system and sex hormone
| €15 | (€65) | €13 | (€58) | €12 | (€51) | €18 | (€72) | €14 | (€52) |
H-Systemic hormonal preparations, excl. sex hormones and insulins
| - | - | - | - | - | - | - | - | €8 | (€192) |
J-Antiinfectives for systemic use
| €39 | (€419) | €36 | (€418) | €19 | (€39) | €69 | (€416) | €38 | (€492) |
L-Antineoplastic and immunomodulating agents
| €70 | (€881) | €82 | (€921) | €27 | (€233) | €141 | (€1371) | €78 | (€906) |
M-Musculo-skeletal system
| €27 | (€88) | €25 | (€63) | €27 | (€121) | €24 | (€56) | €28 | (€98) |
N-Nervous system
| €0 | (€0) | €0 | (€0) | €0 | (€0) | €0 | (€0) | €0 | (€0) |
Psychotropics
| €50 | (€241) | €42 | (€183) | €44 | (€145) | €82 | (€246) | €33 | (€146) |
Other nervous system product
| €91 | (€255) | €92 | (€269) | €92 | (€247) | €181 | (€430) | €74 | (€293) |
P-Antiparasitic products, insecticides and repellents
| €0 | (€5) | €0 | (€3) | €1 | (€6) | €1 | (€7) | €0 | (€0) |
R-Respiratory system
| €58 | (€223) | €46 | (€173) | €46 | (€179) | €86 | (€295) | €43 | (€188) |
S-Sensory organs
| €38 | (€279) | €32 | (€230) | €24 | (€118) | €33 | (€193) | €29 | (€275) |
V-Various
| €9 | (€139) | €8 | (€72) | €5 | (€17) | €8 | (€28) | €9 | (€255) |
Total
| €1113 | (€1,411) | €1,381 | (€1,435) | €1,701 | (€868) | €2,615 | (€2,089) | €644 | (---) |
Patients with declining renal function
Pharmacy | Consultation (GP/specialist) | Nursing care | Total ambulatory care costs | ||
---|---|---|---|---|---|
Monotherapy (N = 411) | m (σ) | 1,798 (2,433) | 307 (252) | 143 (683) | 4,226 (5,369) |
Increase rate vs NRF | 56% | 20% | 0% | 40% | |
Double therapy (N = 267) | m (σ) | 1,893 (3,908) | 301 (171) | 210 (963) | 4,159 (5,268) |
Cost ratio vs mono (%) | 1.094* | 0.978 | 0.736 | 0.959 | |
Increase rate vs NRF | 34% | 21% | 38% | 26% | |
Triple therapy (N = 78) | m (σ) | 2,141 (3,056) | 305 (152) | 99 (504) | 4,032 (4,329) |
Cost ratio vs mono (%) | 1.262 *** | 1.029 | 0.903 | 1.031 | |
Increase rate vs NRF | 19% | 17% | 5% | 12% | |
Insulin therapy (N = 267) | m (σ) | 3,889 (5,363) | 422 (340) | 2,161 (3,638) | 11,344 (11,185) |
Cost ratio vs mono (%) | 2.020 *** | 1.230 *** | 10.236 *** | 2.223*** | |
Increase rate vs NRF | 47% | 28% | 36% | 53% |