Abstract
The methodology defines methods for (i) identification of patients with type 2 diabetes mellitus using individual data on medication consumption reported to Czech health insurance funds, (ii) determination of their costs on health care covered by statutory health insurance, and (iii) for prediction of prevalence of type 2 diabetes and costs of these patients. The methodology further establishes application of these methods to other chronic diseases.
Identification of patients with type 2 diabetes is based on consumption of pharmaceuticals classified into Anatomical Therapeutic Chemical (ATC) group A10B - Blood glucose lowering drugs, excluding insulins, which are typical for diabetes treatment. The prevalence is set using individual data of reimbursement of pharmaceuticals by statutory health insurance that covers all insurees in the Czech Republic.
Estimation of expected prevalence takes into account demographic prediction and is set in two different scenarios (constant prevalence and increasing prevalence based on actual trend). Determination of costs assigned to a patient is based on methodology of Ministry of Health of CR that is being employed for setting parameters for pooling of collected insurance premiums among health insurance funds.
Estimation of future costs is based on their preceding evolution and together with estimation of future prevalence takes into account various factors (time effect, demographic changes, changes in prevalence). The estimation considers several scenarios to cover all potential changes in evolution of prevalence and costs.
Employing appropriate assumptions on patient identification, the methodology can be used for another chronic diseases. Necessary conditions are discussed in the final part of the methodology.