OBJECTIVES: The management of type-2 diabetes mellitus (T2DM) is costly since it is highly associated with hospitalization and complications, particularly when the management is poor. Clinicians use HbA1c level as intermediate outcome indicator of management. In this research, we aim to assess cost associated with HBA1c level in DMT2 patients in Flanders within the primary care setting.

METHODS: Using Belgium Health Insurance data, we analyzed total of 5,080 patients aged >=65 y.o. who have undergone at least 1 HbA1c testing annually. We divided the population into two groups : those who have HbA1c <= 7% (categorized as controlled), and HbA1c > 7% (uncontrolled). The cost is calculated using the payer perspective, entailing medical cost reimbursed through the insurance system. We conducted propensity score matching (PSM), particularly with (i) socioeconomic variable such as age, sex, quintile income, and financing of care, and (ii) clinical variable such as visits, complications, and comorbidities option as control variable to the cost of two groups.

RESULTS: The descriptive results show that patients that uncontrolled T2DM comes from lower income quintile and tend to use capitation as mean for financing care. Clinically, T2DM patients who is in uncontrolled is associated with more complications during treatment. Before matching, the average yearly treatment T2DM in uncontrolled group was Eur €3,208 while the controlled group was €3,108. The cost after matching was €3,208 for the uncontrolled group, and €3,213 for the controlled group.

CONCLUSIONS: We observe a difference in cost of treatment between uncontrolled and controlled diabetes group based on HbA1c level. The clinical indicators such as visits, complications, and comorbidities might play role as drivers of cost for treatment.