Improvement of Care & Outcome


Silvia de Vries, Jessica Bak, Carianne Verheugt, Vincent Stangenberger, Dick Mul, Michel Wouters, Max Nieuwdorp, Theo Sas

Healthcare expenditure and technology use in pediatric diabetes care. BMC Endocr Disord. 2023 Apr 7;23(1):72.

The number of people with type 1 diabetes (PWDs) is still increasing. As type 1 diabetes can not yet be prevented or cured, optimal treatment and prevention of (long-term) complications are necessary. New technology has come a long way in improving both glycemic outcomes and quality of life of people with T1D. Increasing numbers of PWDs combined with increasing costs for new technology pose an increasing burden on healthcare resources, with costs expecting to rise even more due to increasing use of newer and more sophisticated technologies. Not many studies have investigated healthcare use and costs in pediatric care on a national level. This study, co-authored by Diabeter pediatric endocrinologists Dick Mul and Theo Sas, aimed to asses healthcare resource utilization, hospital costs and its determinants in Dutch children and adolescents (0-18 years) with diabetes.


In this retrospective, observational, nationwide cohort study, Dutch healthcare reimbursement data of 5,474 children with diabetes were used. In the Netherlands a national diagnosis coding system, the Diagnosis Treatment Combinations (DBC) system is used. No distinction can be made between type 1 and type 2 diabetes as no codes are specified for this. A dataset with benchmark information on claimed care products (i.e. DBCs) between 1 January 2019 and 31 December 2019 from affiliated hospitals was provided by LOGEX Healthcare Analytics.

Key findings:

  • Children visited the pediatric department a median of 7 times per year
  • Technology use:
    • Insulin pump: 56%
    • Real-time continuous glucose monitoring (rtCGM): 29%
    • Both insulin pump and rtCGM: 27%
  • Children using technology showed a lower hospitalization rate
  • Annual total hospital costs for these 5,474 children were €33,002,652 (€6,029 per child), with 85% being diabetes-associated (€5,143 per child)
  • Annual costs technology use per child (median):
    • No technology use: €2,418
    • Insulin pump: €4,009
    • Real-time continuous glucose monitoring (rtCGM): €6,474
    • Both insulin pump and rtCGM: €7,911
  • Increasing consultation costs and decreasing clinical costs with technology use
  • Mean annual costs were highest for children 1-5 years old and lowest in children 16-17 years old
  • Technology use was highest for children 1-10 years old and lowest in adolescents

Concluding, the authors state

"These findings suggest that contemporary hospital costs of children with diabetes of all ages are driven primarily by the treatment of diabetes, with technology use as an important additive factor. The expected rise in technology use in the near future underlines the importance of insight into resource use and cost-effectiveness studies to evaluate if improved outcomes balance out these short-term costs of modern technology" -

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