Economic burden associated with alcohol dependence in a German primary care sample : a bottom-up study

BACKGROUND: A considerable economic burden has been repeatedly associated with alcohol dependence (AD) - mostly calculated using aggregate data and alcohol-attributable fractions (top-down approach). However, this approach is limited by a number of assumptions, which are hard to test. Thus, cost estimates should ideally be validated with studies using individual data to estimate the same costs (bottom-up approach). However, bottom-up studies on the economic burden associated with AD are lacking. Our study aimed to fill this gap using the bottom-up approach to examine costs for AD, and also stratified the results by the following subgroups: sex, age, diagnostic approach and severity of AD, as relevant variations could be expected by these factors. METHODS: SAMPLE: 1356 primary health care patients, representative for two German regions. AD was diagnosed by a standardized instrument and treating physicians. Individual costs were calculated by combining resource use and productivity data representing a period of six months prior to the time of interview, with unit costs derived from the literature or official statistics. The economic burden associated with AD was determined via excess costs by comparing utilization of various health care resources and impaired productivity between people with and without AD, controlling for relevant confounders. Additional analyses for several AD characteristics were performed. RESULTS: Mean costs among alcohol dependent patients were 50 % higher compared to the remaining patients, resulting in 1836 € excess costs per alcohol dependent patient in 6 months. More than half of these excess costs incurred through increased productivity loss among alcohol dependent patients. Treatment for alcohol problems represents only 6 % of these costs. The economic burden associated with AD incurred mainly among males and among 30 to 49 year old patients. Both diagnostic approaches were significantly related to the economic burden, while costs increased with alcohol use disorder severity but not with other AD severity indicators. CONCLUSIONS: Our study confirms previous studies using top-down approaches to estimate the economic burden associated with AD. Further, we highlight the need for efforts aimed at preventing adverse outcomes for health and occupational situation associated with alcohol dependence based on factors associated with particularly high economic burden

Cardiovascular diseases and diabetes:Results from the danish diabetes impact study

We present an investigation of the occurrence of cardiovascular disease in patients with diabetes in Denmark 2000 through 2011. The Diabetes Impact Study 2013 is based on all registrants in the Danish National Diabetes Register as of July 3rd 2013 (n=497,232). Record linkage with the Danish National Patient Register was used to defining the first date of experiencing a cardiovascular event by means of a discharge diagnosis and/or having performed a coronary bypass operation or revascularization of the coronary arteries. The proportion of patients with already established CVD at the diagnosis of diabetes has been rather constant at higher level in males (around 16-18%) than in females (around 12-14%) during 2000-2011 (incl.). In contrast, the incidence rate of CVD after having diabetes diagnosis has declined from about 4.5 to less than 3 during the same period, with higher declining level for males than for females. Efforts to detect diabetes at an earlier stage have not resulted in a reduced occurrence of CVD at the diagnosis of diabetes in Denmark. However, the risk of developing CVD after the diagnosis of diabetes has been declining, possibly reflecting benefits of intensified treatment in Danish patients with diabetes

The Changing Epidemiology of Renal Replacement Therapy in Diabetes. Results from the Diabetes Impact Study 2013, Denmark

Aims : We present an investigation of first-time renal replacement therapy in patients with diabetes in Denmark 2000 through 2011. Methods: The Diabetes Impact Study 2013 is based on all registrants in the Danish National Diabetes Register as of July 3rd 2013 (n=497,232). Record linkage with the Danish National Patient Register was used to define the first date of experiencing complications including dialysis and/or kidney transplant. Results: The prevalence of diabetes rose exponentially due to increasing incidence of diabetes and declining mortality. Even though the rate of developing complications (grouped into complications of intermediate and major impact) decreased, the rate of first time dialysis and first time kidney transplantation remained constant. Conclusions: In spite of reducing the risk of developing long term complications in diabetes, the rate of commencing renal replacement therapy has remained constant. Further in-depth studies are needed to explain this unexpected finding

The Changing Epidemiology of Renal Replacement Therapy in Diabetes. Results from the Diabetes Impact Study 2013, Denmark

Aims : We present an investigation of first-time renal replacement therapy in patients with diabetes in Denmark 2000 through 2011. Methods: The Diabetes Impact Study 2013 is based on all registrants in the Danish National Diabetes Register as of July 3rd 2013 (n=497,232). Record linkage with the Danish National Patient Register was used to define the first date of experiencing complications including dialysis and/or kidney transplant. Results: The prevalence of diabetes rose exponentially due to increasing incidence of diabetes and declining mortality. Even though the rate of developing complications (grouped into complications of intermediate and major impact) decreased, the rate of first time dialysis and first time kidney transplantation remained constant. Conclusions: In spite of reducing the risk of developing long term complications in diabetes, the rate of commencing renal replacement therapy has remained constant. Further in-depth studies are needed to explain this unexpected finding