Faculty of Biology, Medicine and Health Email: adrian.heald@manchester.ac.uk

INTRODUCTION

METHOD

CONCLUSION

National Diabetes Audit https://digital.nhs.uk/data-and-

information/publications/statistical/national-diabetes-inpatient-audit

Hospital Episode Statsistics https://digital.nhs.uk/data-and-information/data-tools-and-

services/data-services/ hospital-episode-statistics

GP Practice registered Populations by age https://digital.nhs.uk/data-and-

information/publications/statistical/ patients-registered-at-a-gp-practice

Compare cost of hospital treatment of Type 1 diabetes (T1DM) and Type 2 diabetes

(T2DM) to non-diabetes population (Non-D): a more detailed economic evaluation

REFERENCES

Other than age, diabetes is the largest contributor to overall health care costs and

reduced life expectancy in Europe. People with T1DM and T2DM require higher

levels of hospital support than their non-diabetes counterparts. Health care

provision in hospital can be broken down into four main areas: 1) planned/elective

2)emergency/non-elective 3)Accident & Emergency and 4)Outpatient attendances.

The National Diabetes Inpatient Audit has shown that 18% of all hospital beds are

occupied by people who have a diagnosis of diabetes compared to a 7%

prevalence of diabetes in the population. This overstates the impact of the

condition as over 90% of people with diabetes have T2DM and so older than the

general population so their normal healthcare requirements would be higher. NHS

England publishes significant amount of data at GP practice level and we have

previously described the impact a variety of population, service and prescribing

factors on outcomes. It was felt that this approach could be used to quantify and

so adjust for the effect of age on different services that are provided in hospital to

T2DM individuals and therefore achieve a much more accurate evaluation of the

actual net cost of diabetes, including all associated comorbidities to the health

service. The National Diabetes Audit also reported on glycaemic control which

showed 70% of T1DM and 34% of T2DM patients have HbA1c results >

58mmol/mol and so are at increased risk of adverse health impacts. We initially

included this glycaemic control as a factor within this analysis but was shown to be

strongly affected by the historic nature and increased mortality the data for which

was not captured see figure 1.

Our objective was to more exactly quantify the net impact of diabetes on the

different aspects of healthcare provision within hospitals in England. We wished to

use this analysis to provide a clearer focus for local diabetes services to determine

which elements of care they can focus on in order to improve outcomes.

The total annual activity in each GP Practice for emergency, elective, A&E and

outpatient care, for patients with diagnosis of T1DM and T2DM and the non-D

individuals was extracted from NHS Digital Hospital Episode Statistics (HES) for

2016_17 and 2017_18. The population of T1DM and T2DM individuals and their

age groups at GP practice level was taken from NHS Digital National Diabetes

Audit (4). Public Health England publishes the patient numbers and age profile of

each GP practice. The demographic and locational data for each practice including

social deprivation, population density (urban/rural), Latitude (Northerliness) were

taken from the Office of National Statistic (ONS). The % minority ethnicity was also

determined.

.

Total overall hospital costs in each of the three classes (T1DM, T2DM, and non-D)

were calculated by adding the tariff charges to the Outpatient and Accident &

Emergency attendances each multiplied by the national overall average cost /

attendance. Included practices with complete data sets plus >200 T2DM patients

or > 20 T1DM patients on their register

Investment in diabetes medication and services ensure that 62% of people tested

have controlled their glycaemia during the previous 3 months, however the lack of

glycaemic control in the residual number of patients and long amounts of time,

impact in increased mortality and hospital costs. These increased hospital costs,

40% of which come from non elective/emergency spend, are three times higher

than the current diabetes medication spend and could be seen as accrueing to the

non controlled cohort which would be around 700,000 in number.

There are still opportunities to reduce potential future additional costs through

increased investment in local services and medication for diabetes treatment.

Supporting patients in diabetes management could significantly reduce hospital

activity including emergency bed occupancy of people with T1DM/T2DM.

The next major stage in this project is to include longer term historic patient level

glycaemic control and current mortality to quantify the impact of these on the

healthcare resources

1Res Consortium, Andover, Hampshire; 2The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester; 3Department of Clinical Biochemistry, Walsall Manor Hospital; 4Department of Clinical Biochemistry,

Royal Stoke Hospital, 5Keele University, 6Warwick Medical School, University of Warwick, 7Department of Diabetes and Endocrinology, Ipswich General Hospital, 8Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK

M Stedman1, M Lunt2, M Davies1, M Livingston3, C Duff4,5, A Fryer4,5, S Anderson2, R Gadsby6, J M Gibson2, G Rayman7, A Heald1,8

RESULTS

We initially included this glycaemic control as

a factor within this analysis but was shown to

be strongly affected by the historic nature and

increased mortality the data for which was not

captured see figure 1.

Our objective was to more exactly quantify the

net impact of diabetes on the different aspects

of healthcare provision within hospitals in

England. We wished to use this analysis to

provide a clearer focus for local diabetes

services to determine which elements of care

they can focus on in order to improve

outcomes.

The study captured 90% of the hospital activity and £36billion/year of hospital

spend. The NDA Register showed that out of a total reported population of 58

million, 2.9 million (6.5%) had T2DM and 240 thousand (0.6%) had T1DM. Bed

day analysis showed 17% of beds are occupied by T2DM and 3% by T1DM.

Overall cost of hospital care for people with diabetes is £5.5billion/year. Once the

normal expected costs including the older age of T2DM hospital attenders are

allowed for this fell to £3.0 billion/year or 8% of the total captured secondary care

costs. This equates to £560/non-diabetes person compared to £3,280/person with

T1DM and £1,686/person with T2DM.

Figure 2: Highlight the variances in population age between non diabetes, T1DM

and T2DM. It also shows how the costs/person in practices vary with % age >75

and the correlation coefficient that can be used to reflect that.

Figure 3: Shows the regression results for the 5 major activities showing the

relative impact each factor and how age plays different roles in each activity

Figure 4: Shows how diabetes has additional impact on certain activities more

than others with T1 having larger impact. Than its relative numbers. In summary

14% of emergency costs, 9% of elective costs, 6% of outpatient attendances and

2% can be related to excess costs of diabetes.

Table 1 show the detailed outcomes. The net excess annual cost impact for people

with diabetes on non-elective/ emergency work is £1.24billion, elective work is

£0.86billion, outpatient charges £0.87billion and A&E attendances £0.07billion.

T1DM individuals required five times more and T2DM individuals, even allowing

for the age, require twice as much secondary care support than non-diabetes

individuals.

If these additional costs are restricted onto the smaller group that have not

controlled their glycaemia then these costs/head rise to 7.5 higher for T1DM and 5

times for T2DM compared to non D.

Allow for DMT2 age

difference in each aspect