Valorisation des bases médico-administratives de l'assurance maladie pour identifier et suivre la progression d'une pathologie, en étudier la prise en charge et estimer l'impact de l'implémentation d'une politique de santé grâce à leur utilisation dans un modèle médico-économique: Application au diabète de type 2 au Luxembourg

[Valorization of health insurance medico-administrative databases to identify and follow the progression of a disease, study its management and estimate the impact of a health policy implementation using a health-economic model: application to type 2 diabetes in Luxembourg]
Type 2 diabetes (T2D) is a chronic disease associated with many severe and costly complications. In a context of budgetary constraint, it is necessary to obtain an estimate the amount of resources to allocate to the management of chronic diseases. This includes monitoring the epidemiologic and economic evolutions. A database was built from medico-administrative databases of the national health insurance of Luxembourg. It included the healthcare consumptions associated with diabetes and its complications, of all type 2 diabetic patients treated in Luxembourg between 2000 and 2006. The objectives were to study the fields of use of this database and the possible applications for public health decision-making. This thesis gives some examples. In 2006, T2D prevalence in Luxembourg was 3.79% (N= 17070). An algorithm was built and permitted to identify three stages of diabetic nephropathy (3.77% of T2D cases in 2006). The analysis of the adherence to European follow-up guidelines showed a critical situation associated to several factors (treating physician, type of treatment, living region…). The mean costs associated with patients in dialysis were estimated at 116 647€/patient in 2006. Finally, a health-economic evaluation showed the dominance of a strategy promoting peritoneal dialysis in Luxembourg over the present situation