Spaans E A J M, van Dijk P R, Groenier K H, Brand P L P, Kleefstra N, Bilo H J G
Diabetes Centre, Isala, P.O. box 10400, 8000, GK, Zwolle, the Netherlands.
Princess Amalia Children's Clinic, Isala, Zwolle, the Netherlands.
BMC Endocr Disord. 2018 Aug 17;18(1):57. doi: 10.1186/s12902-018-0287-6.
Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in children. Studies on costs related to T1DM are scarce and focused primarily on the costs directly related to diabetes. We aimed to investigate both the overall healthcare costs and the more specific costs related to the management of diabetes.
This is a retrospective and observational, nationwide cohort study of all Dutch children (aged 0-18 years) with T1DM. Data were collected from the national registry for healthcare reimbursement, in which all Dutch insurance companies combine their reimbursement data. In the Netherlands for all Dutch citizens health care is covered by law and all children are treated by hospital-based paediatricians.
We analysed 6710 children distributed over 81 hospitals: 475 children in 6 university hospitals and 6235 children in 75 general hospitals. Total reimbursement for all children with T1DM over the period 2009 to 2011 was € 167,494,732 corresponding to an annual mean of € 55,831,577 of total costs and € 8326 euros per child. When comparing small (between 26 and 54 patients), medium (57-84 patients) and large (88-248 patients) general hospitals, costs per patient were highest in the hospitals with the highest number of T1DM patients. The costs for devices, secondary care and pharmaceutics had most impact on total expenditures. Over the study period, there was a slight decrease in per person costs.
The overall health expenditure of a child with T1DM is more than € 8000 per patient per annum. Given the move towards more device-intensive multidisciplinary care for these patients, the costs of treating T1DM in children are likely to increase further in the coming years.
1型糖尿病（T1DM）是儿童中最常见的慢性病之一。关于T1DM相关成本的研究较少，且主要集中在与糖尿病直接相关的成本上。我们旨在调查总体医疗成本以及与糖尿病管理相关的更具体成本。
这是一项针对所有荷兰T1DM儿童（0至18岁）的回顾性观察性全国队列研究。数据从国家医疗报销登记处收集，荷兰所有保险公司都将其报销数据汇总于此。在荷兰，所有荷兰公民的医疗保健都依法覆盖，所有儿童均由医院的儿科医生治疗。
我们分析了分布在81家医院的6710名儿童：6家大学医院中有475名儿童，75家综合医院中有6235名儿童。2009年至2011年期间，所有T1DM儿童的总报销费用为167,494,732欧元，相当于总成本年均55,831,577欧元，每名儿童8326欧元。比较小型（26至54名患者）、中型（57至84名患者）和大型（88至248名患者）综合医院时，T1DM患者数量最多的医院中每位患者的成本最高。设备、二级护理和药品成本对总支出影响最大。在研究期间，人均成本略有下降。
一名T1DM儿童的总体医疗支出每年超过每名患者8000欧元。鉴于这些患者正朝着更多设备密集型多学科护理发展，未来几年儿童T1DM的治疗成本可能会进一步增加。
