Introduction
Methodology
Data
Scope of the study
Scope of expenditure
The cohort of incident-treated type 2 diabetic patients in 2008
The control group
Matching method and results
Matched cases | Potential controls | Matched controls | |
---|---|---|---|
Matching variables | |||
Mean age in 2008 | 63.5 years | 61.8 years*** | 63.5 years |
Proportion of men | 52.6% | 40.8%*** | 52.6% |
Place of residence in the most deprived quintile | 21.3% | 25.5%*** | 21.3% |
Place of residence in the least deprived quintile | 20.3% | 16.0%*** | 20.3% |
DOM–TOM residents | 3.8% | 1.8%*** | 3.8% |
Control variables | |||
Percentage of patients hospitalised (all reasons) | 27.1% | 21.9%*** | 23.8%*** |
Percentage of patients covered by CMU-C (45–60 years) | 13.8% | 6.1%*** | 7.0%*** |
At least one cardiology ALD (disabling stroke, chronic peripheral artery disease, severe heart failure, hypertension, or coronary heart disease) | 17.7% | 11.1%*** | 14.2%*** |
At least one ALD (excluding multiple diseases) | 38.2% | 26.0%*** | 28.7%*** |
Number of individuals | 170,010 | 13,413,578 | 510,022 |
Estimation of the excess cost attributable to diabetes
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ALD 1 (disabling stroke), 3 (chronic peripheral artery disease), 5 (heart failure), or 12 (hypertension);
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ALD 11 (haemophilia and clotting disorders);
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ALD 15 (Alzheimer’s disease) or 16 (Parkinson’s disease);
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ALD 23 (psychiatric illness);
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ALD 30 (malignant tumour);
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another ALD.
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before 2008, non-consumers did not receive any reimbursements from the strict general scheme: the value zero is attributed to each type of expenditure;
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from 2008 onwards, all non-consumers died are excluded from the analysis from the year following their death:
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when a matched case died, the associated controls are excluded;
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when a control died, the cases are only excluded when all associated controls died; otherwise, the mean expenditure of the surviving controls was used.
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Econometric strategy
Results
Growth of reimbursed expenditure of incident diabetic patients in 2008
Year | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 |
---|---|---|---|---|---|---|---|---|---|---|
Primary care | ||||||||||
General practitioner care | €137 | €145 | €183 | €182 | €178 | €181 | €179 | €176 | €177 | €207 |
Other specialist care | €167 | €170 | €204 | €203 | €206 | €211 | €209 | €212 | €220 | €227 |
Dental care | €54 | €53 | €52 | €52 | €50 | €50 | €48 | €48 | €48 | €49 |
Midwifery | €0 | €0 | €0 | €1 | €0 | €0 | €0 | €0 | €0 | €0 |
Physiotherapy | €72 | €79 | €90 | €97 | €99 | €100 | €106 | €114 | €120 | €125 |
Nursing care | €98 | €126 | €270 | €327 | €346 | €369 | €407 | €446 | €489 | €531 |
Other paramedical care | €5 | €5 | €7 | €8 | €9 | €9 | €10 | €11 | €13 | €14 |
Clinical pathology | €84 | €91 | €135 | €131 | €133 | €131 | €127 | €127 | €127 | €128 |
Drugs | €760 | €799 | €1021 | €1146 | €1182 | €1197 | €1183 | €1164 | €1252 | €1207 |
Medical devices and services | €116 | €142 | €258 | €276 | €290 | €291 | €299 | €317 | €342 | €365 |
Transportation | €87 | €99 | €134 | €141 | €149 | €155 | €165 | €179 | €193 | €210 |
Other primary care | €8 | €8 | €8 | €8 | €9 | €9 | €9 | €9 | €9 | €10 |
Total primary care | €1588 | €1718 | €2362 | €2571 | €2651 | €2703 | €2741 | €2803 | €2989 | €3074 |
Hospital care | ||||||||||
Total private sector | €399 | €396 | €476 | €476 | €476 | €486 | €500 | €514 | €545 | €570 |
Total public-sector | NA | NA | €1327 | €1109 | €1107 | €1127 | €1199 | €1215 | €1302 | €1408 |
Total (public and private) | NA | NA | €1803 | €1585 | €1583 | €1613 | €1698 | €1730 | €1847 | €1977 |
Cash benefits | ||||||||||
Sickness benefits and work accidents/occupational diseases | €281 | €282 | €321 | €276 | €232 | €199 | €177 | €159 | €152 | €142 |
Disability benefits | €283 | €258 | €256 | €301 | €314 | €319 | €331 | €326 | €322 | €314 |
Total cash benefits | €564 | €540 | €577 | €576 | €546 | €518 | €508 | €486 | €475 | €456 |
Total expenditure | ||||||||||
Total expenditure other than hospitalisations | €2632 | €2744 | €3527 | €3734 | €3793 | €3838 | €3889 | €3948 | €4158 | €4260 |
Total expenditure | NA | NA | €4742 | €4733 | €4779 | €4835 | €4947 | €5018 | €5311 | €5507 |
Estimation of the excess cost attributable to treated type 2 diabetes by the simple differences method
Year | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 |
---|---|---|---|---|---|---|---|---|---|---|
Primary care | ||||||||||
Total primary care | €175 | €96 | €756 | €886 | €958 | €1005 | €1050 | €1104 | €1222 | €1260 |
Hospital care | ||||||||||
Total private sector | €41 | − €37 | €54 | €40 | €44 | €55 | €70 | €83 | €102 | €120 |
Total public-sector MSO | NA | NA | €552 | €258 | €208 | €228 | €315 | €305 | €366 | €409 |
Total MSO (public and private) | NA | NA | €607 | €298 | €251 | €282 | €384 | €387 | €468 | €530 |
Cash benefits | ||||||||||
Sickness benefits and work accidents/occupational diseases | €31 | €19 | €97 | €66 | €32 | €14 | €9 | €9 | €9 | €9 |
Disability benefits | €41 | €16 | €22 | €46 | €66 | €77 | €84 | €87 | €89 | €89 |
Total cash benefits | €72 | €35 | €119 | €112 | €97 | €91 | €93 | €96 | €98 | €98 |
Total expenditure | ||||||||||
Total expenditure (excluding public-sector hospitalisations) | €310 | €106 | €956 | €1051 | €1119 | €1175 | €1247 | €1316 | €1451 | €1519 |
Total expenditure (hospitalisations: MSO only) | NA | NA | €1482 | €1295 | €1307 | €1378 | €1528 | €1588 | €1788 | €1889 |
Primary care
Hospitalisations
Cash benefits
Estimation of excess cost by DiD
2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | |
---|---|---|---|---|---|---|---|---|
Total expenditure | €896 | €978 | €1044 | €1102 | €1174 | €1243 | €1385 | €1452 |
Primary care | €695 | €816 | €889 | €940 | €987 | €1044 | €1169 | €1205 |
Private-sector hospitalisations | €91 | €56 | €63 | €75 | €98 | €107 | €123 | €153 |
Cash benefits | €99 | €94 | €81 | €75 | €79 | €81 | €82 | €82 |
Simple difference and DiD methods: a comparison
Method | Simple difference | DiD | Percentage difference |
---|---|---|---|
Primary care | €1030 | €968 | − 6 |
Private-sector hospitalisations | €71 | €96 | 35 |
Cash benefits | €101 | €84 | − 16 |
Total (excluding public-sector hospitalisations) | €1202 | €1159 | − 4 |