Ten-Year Trends in Healthcare Use and Costs for People Living with Diabetes in France: Results from the Epicodiab Study Based on National Claims Data

Introduction: Diabetes remains a global public health concern, with increased prevalence and a significant economic burden. Yet, most studies do not differentiate between type 1 (T1D) and type 2 diabetes (T2D), despite distinct clinical trajectories and care needs. This study aimed to provide up-to-date data on healthcare use and diabetes care-related costs in France from 2011 to 2019 by type of diabetes. Methods: A 10-year retrospective study was conducted on adults identified with T1D and T2D between 1 January 2010, and 31 December 2019, in a 1/10th sample of the French nationwide claims database (SNDS, Système National des Données de Santé). In the hospital database, reimbursement data are available only from 2011, so resource use and cost analyses were conducted starting from 2011 to 2019 in this present study. Diabetes was identified through hospital diagnoses, specific treatments, and/or long-term conditions. A machine-learning algorithm was specifically developed through a linkage between SNDS data and primary data from a network of French general practitioners to better predict the type of diabetes. Results: In 2019, among the 290,486 treated individuals, 12,102 (4.2%) had T1D, 62,479 (21.5%) had insulin-treated type 2 diabetes (T2Di), and 215,905 (74.3%) had noninsulin-treated type 2 diabetes (T2Dni). Average total reimbursed costs per individual varied significantly by diabetes group: €10,033 (T1D), €13,424 (T2Di), and €5091 (T2Dni), primarily owing to primary care settings (63.6% to 71.8% of the total cost). Between 2011 and 2019, total reimbursement costs increased (+ 9.6% for T1D, + 29.8% for T2Di, and + 13.8% for T2Dni), while average cost per individual decreased (−9.6% for T1D, −7.7% for T2Di, and −1.0% for T2Dni). Conclusions: As its prevalence continues to rise, the economic burden of diabetes also grows overall, despite the reduction in individual costs.