Costs associated with emergency care and hospitalization for severe hypoglycemia G. Veronese a,b, *, G. Marchesini a , G. Forlani a , S. Saragoni c , L. Degli Esposti c , E. Centis a , A. Fabbri d , the Italian Society of Emergency Medicine (SIMEU) a Department of Medical and Surgical Sciences, Unit of Metabolic Diseases & Clinical Dietetics, University of Bologna, Bologna, Italy b Department of Emergency Medicine, Ospedale Niguarda Ca’ Granda, University of Milano-Bicocca, Milano, Italy c Clicon S.r.l, Health, Economics & Outcome Research, Ravenna, Italy d Department of Emergency Medicine, Morgagni-Pierantoni Hospital, Forli  , Italy Received 22 June 2015; received in revised form 29 November 2015; accepted 11 January 2016 Available online --- KEYWORDS Hypoglycemia; Emergency department; Economic burden; Prevention Abstract Background and aims: We aimed to determine the direct economic cost of the man- agement of severe hypoglycemia among people with diabetes in Italy. Methods and results: Data of cases with an acceptance diagnosis of hypoglycemia between January 2011 and June 2012 were collected in 46 Emergency Departments (EDs). Emergencycare costs were computed by estimating the average cost per ambulance service, ED visit and short- term (<24 h) observation period. Hospitalization expenditure was estimated using the average cost reimbursed by the Italian healthcare system for hospital admission per patient with diabetes in a specific hospital ward.We retrieved 3516 hypoglycemic episodes occurring in subjects with diabetes. Half the cases (51.8%) required referral to EDs by means of the emergency ambulance services. A total of 1751 cases (49.8%) received an ED visit followed by discharge; 604 cases (17.2%) received a short-term observation period; 1161 (33.1%) were hospitalized. Unit costs for emergency care management were estimated at V205 for an ambulance call, V23 for an ED visit, and V220 for a short-term observation. The mean hospitalization cost was estimated at V5317; the average cost per each severe hypoglycemic event totaled V1911. From a base case assumption, the total direct cost of severe hypoglycemia in patients with diabetes in Italy was estimated to be approximately V23 million per year. Conclusion: Severe hypoglycemia in patients with diabetes constitutes a remarkable economic burden for national healthcare systems. Measures for preventing hypoglycemia are mandatory in diabetes management programs considering the impact on patients and on health spending. ª 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Feder- ico II University. Published by Elsevier B.V. All rights reserved. Introduction Hypoglycemia is a major limiting factor in the glycemic control of patients with diabetes [1]. Mild episodes may be frequent and markedly impact quality of life [2,3]. Recurrent hypoglycemia favors the loss of physiologic de- fenses against hypoglycemia that in turn increases the risk of severe hypoglycemia [4]. Severe events, defined as ep- isodes requiring third-party assistance, have been associ- ated with adverse clinical outcomes, including hospitalization and death [5e8]. The risk of hypoglycemia is particularly high in type 1 diabetes. Nonetheless, also in type 2 diabetes, the broader use of insulin in elderly patients with long-standing dis- ease and a frailty profile contribute to a very high risk of hypoglycemia [9]. The magnitude of the problem has been * Corresponding author. Department of Medical and Surgical Sci- ences, Unit of Metabolic Diseases & Clinical Dietetics, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. Tel.: þ39 051 6364889; fax: þ39 051 6364502. E-mail address: veronese.giacomo@gmail.com (G. Veronese). Please cite this article in press as: Veronese G, et al., Costs associated with emergency care and hospitalization for severe hypoglycemia, Nutrition, Metabolism & Cardiovascular Diseases (2016), http://dx.doi.org/10.1016/j.numecd.2016.01.007 http://dx.doi.org/10.1016/j.numecd.2016.01.007 0939-4753/ª 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved. Nutrition, Metabolism & Cardiovascular Diseases (2016) xx,1e7 Available online at www.sciencedirect.com Nutrition, Metabolism & Cardiovascular Diseases journal homepage: www.elsevier.com/locate/nmcd