Real-World Evidence of Healthcare Utilization and Costs for Type 1 Diabetes and Severe Hypoglycemia by Age in Germany

OBJECTIVES: To evaluate the healthcare resource utilization (HCRU) and costs for people with type 1 diabetes (T1D) and those with severe hypoglycemia in Germany by age.

METHODS: Adults (≥18 years old) with T1D were selected from a German BKK claims database between January 1, 2013 and December 31, 2020. T1D was defined as ≥1 specific diagnostic code (ICD-10) in ≥2 quarters of a year (M2Q), a ratio of >0.5 for T1D over T2D M2Q diagnoses, ≥1 insulin prescription, and no non-insulin glucose-lowering drug prescriptions except for off-label use. The index date was defined as date of the first observed T1D diagnosis code after 12 months’ continuous enrollment for the T1D population. A subpopulation with T1D and severe hypoglycemia (HYPO + inpatient [IP] cohort) was indexed on date of the first observed hypoglycemia-associated hospital admission (proxy of severe hypoglycemia). Age-stratified per patient per year (PPPY) HCRU and cost outcomes were examined descriptively.

RESULTS: In the T1D population (N=18,601), higher number of inpatient (mean PPPY: 0.3, 0.4, and 1.0 for 18–44 [n=8,548], 45-64 [n=7,270], and ≥65 [n=2,783] groups, respectively) and outpatient visits (mean PPPY: 23.5, 29.4, and 35.5 for 18–44, 45-64, and ≥65 groups, respectively) were observed for older patients, which drove the mean PPPY healthcare costs of €8,790 overall and €6,929, €8,961, and €14,058 for 18–44, 45–64, and ≥65 age groups, respectively. Similar trends but higher burden were observed for the HYPO+IP cohort (n=736) with mean PPPY healthcare costs of €13,482 overall and €12,217, €13,773, and €19,682 for 18–44 [n=393], 45–64 [n=275], and ≥65 [n=68] age groups, respectively.

CONCLUSIONS: Although disease duration (data unavailable) is a confounder and associated with age, this study showed descriptively that adults with T1D with older age and severe hypoglycemia living in Germany have high burden of HCRU and costs.