1

The Costs of Diabetes in

EuropeDon’t Lose Sight

of the Costs

Rhys WilliamsPrifysgol Cymru Abertawe

(University of Wales Swansea, UK)

2

The Costs of Diabetes in

EuropeWhat are the costs?

What can be done about them?

3

What are the costs?• Direct costs (of health care)

– to society– to the individual and the family

• Indirect costs (of ‘lost production’)– Sickness absence, premature

retirement and premature death• Intangible costs

– Reduced quality of life - anxiety, pain, discomfort etc.

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CODE-2 – the Cost of Type 2 Diabetes

BEL

FRA

GER

ITA

NED

SPA

SWE

UK

All countries

735

751

809

1263

909

1004

773

756

7000

Direct cost (Billions of Euros - 1998)

1.1

4.0

12.4

5.8

0.4

2.0

0.7

2.6

29.0

6

Complications and Hospital Costs

0

1

2

3

4

5

6

Co

st

imp

act

facto

r

None Micro only Macro only Both

2.1x

3.1x

5.5x

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What can be done be done about them?

• People with existing diabetes (type 1 & type 2)– Reducing the risk of complications

• For people at risk of type 2 diabetes– Primary prevention ‘stopping diabetes

before it starts’

• These will reduce direct, indirect and intangible costs

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Intensive therapy is costly to start but less costly in

the long run

0

1000

2000

3000

4000

5000

6000

1 2 3 4 5 6 7 8 9 10

Intensive

Basic

9

Trials have now shown that physical activity and weight

loss reduce risk

Source: The N Engl J Med, Volume 346, No 6, page 399

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Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle Among 522 Overweight Subjects with IGT.The Finnish Diabetes Prevention Study.

-5

0

5

10

15

20

25

Weight Change (kg) Cumulative Incidence ofType 2 Diabetes After 4

Years (%)

Wei

ght

Cha

nge

(kg)

& C

umul

ativ

e

Wei

ght

Cha

nge

(kg)

& C

umul

ativ

e

Inci

denc

e o

f T

ype

2 D

iabe

tes

(%)

Inci

denc

e o

f T

ype

2 D

iabe

tes

(%)

-3.5 kg-3.5 kg -0.8 kg-0.8 kg

11%11%

23%23%

Tuomilehto et al. N. Engl. J. Med (2001). 344, 1343.

P < 0.001P < 0.001

P < 0.001P < 0.001interventionintervention

controlcontrol

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The Costs of Diabetes in

EuropeCosts are high and getting higherComplications are the most important ‘cost driver’Costs can be reduced through primary and secondary prevention