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Diabetes Care. 2018 May;41(5):971-978. doi: 10.2337/dc17-1763. Epub 2018 Jan 18.

Health Care Costs Associated With Incident Complications in Patients With Type 2 Diabetes in Germany.

Author information

Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)-German Research Center for Environmental Health (GmbH), Neuherberg, Germany
German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)-German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
Scientific Institute of the Techniker Krankenkasse for Benefit and Efficiency in Health Care, Techniker Krankenkasse, Hamburg, Germany.
Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, Bremen, Germany.
Research Group Evidence-Based Public Health, Leibniz Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany.
Health Sciences Bremen, Institute for Public Health and Nursing, University of Bremen, Bremen, Germany.



The aim of this study is to provide reliable regression-based estimates of costs associated with different type 2 diabetes complications.


We used nationwide statutory health insurance (SHI) data from 316,220 patients with type 2 diabetes. Costs for inpatient and outpatient care, pharmaceuticals, rehabilitation, and nonmedical aids and appliances were assessed in the years 2013-2015. Quarterly observations are available for each year. We estimated costs (in 2015 euro) for complications using a generalized estimating equations model with a normal distribution adjusted for age, sex, occurrence of different complications, and history of complications at baseline, 2012. Two- and threefold interactions were included in an extended model.


The base case model estimated total costs in the quarter of event for the example of a 60- to 69-year-old man as follows: diabetic foot €1,293, amputation €14,284, retinopathy €671, blindness €2,933, nephropathy €3,353, end-stage renal disease (ESRD) €22,691, nonfatal stroke €9,769, fatal stroke €11,176, nonfatal myocardial infarction (MI)/cardiac arrest (CA) €8,035, fatal MI/CA €8,700, nonfatal ischemic heart disease (IHD) €6,548, fatal IHD €20,942, chronic heart failure €3,912, and angina pectoris €2,695. In the subsequent quarters, costs ranged from €681 for retinopathy to €6,130 for ESRD.


Type 2 diabetes complications have a significant impact on total health care costs in the SHI system, not only in the quarter of event but also in subsequent years. Men and women from different age-groups differ in their costs for complications. Our comprehensive estimates may support the parametrization of diabetes models and help clinicians and policy makers to quantify the economic burden of diabetes complications in the context of new prevention and treatment programs.

[Indexed for MEDLINE]

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