Background and objective: Numerous medications are used in the treatment of
diabetic polyneuropathy (PNP) without evidence of their efficacy. This stu
dy was undertaken to obtain the costs of drugs prescribed to patients with
PNP throughout the Federal Republic of Germany in primary-care practices.
Patients and methods: Data (stored in the Medi-Plus data bank of the Instit
ute for Medical Statistics, Frankfurt) from 400 primary-care practices were
analysed for the year 1996 with regard to diagnoses and prescriptions for
40,112 diabetics over the age of greater than or equal to 20 years. A polyn
europathy (PNP) had been diagnosed in 3548 patients (8.8%) (age: 68+/-12 ye
ars, 56% women). The cost of medications listed for the treatment of PNP wa
s identified and extrapolated to the total prescription cost for treated di
abetic PNP in the whole of Germany. In addition the proportion of costs for
drugs with unproven efficacy was calculated.
Results: Antidepressives were prescribed for 13%, carbamazepine for 4%, and
lipoic (thioctic) acid for 41% of diabetics with PNP. Annual costs per pat
ient (mean value) were DM 203 for lipoic acid, DM 53 for vasoactive drugs a
nd DM 42 for analgesics. Projection for the estimated total number of diabe
tic patients with PNP treated in primary care practices (n = 361,400) gave
a total cost of DM 116 million (95% confidence limit: DM 109-123), of which
DM 41 million (35%) was for medications of unproven efficacy.
Conclusion: In Germany one third of drug costs for diabetic patients with P
NP in primary care is for medications of unproven efficacy. Cost-effective
guidelines for the treatment of diabetic PNP are urgently required.