Predicting factors associated with costs of diabetic patients in Taiwan

Application of type II diabetes incidence and mortality rates for insurance

Prolonging life is a global trend, and more medical expenditure is being spent on chronic diseases owing to population aging. Diseases commonly seen in middle-aged and elderly people, such as heart disease and diabetes, have slowed mortality improvement in recent years. Diabetes is a common chronic disease and comorbidity of many serious health conditions. The total estimated cost of diabetes in the United States was $327 billion in 2017. However, many people are unaware that diabetes is common, and at least 21.4% of adults do not know that they have diabetes. The number of diabetes-related deaths has been increasing, and diabetes was the 5th cause of death in Taiwan in 2019. In this study, we explore the trend and influence of diabetes in Taiwan and apply mortality models, such as the Lee-Carter and Age-Period-Cohort models, using data from Taiwan's National Insurance to model the incidence and mortality rates of diabetes. We found that the Lee-Carter model provides fairly satisfactory estimates and that people with diabetes regularly taking diabetes medication have lower mortality rates. Moreover, we demonstrate how these results can be used to design diabetes related insurance products and prepare the insured to face the impact of incurring diabetes. In addition, we consider different criteria for judging whether people have diabetes (as there is no consensus on these criteria) and investigate the issue of moral hazard in designing diabetes insurance products.

Cost-effectiveness of the add-on exenatide to conventional treatment in patients with Parkinson’s disease when considering the coexisting effects of diabetes mellitus

Objective

This study aims to investigate the cost-effectiveness of the add-on exenatide to conventional pharmacotherapy in patients with Parkinson’s disease (PD) when considering the coexistence of diabetes mellitus (DM).

Methods

We used the Keelung and Community-based Integrated Screening databases to understand the medical utilisation in the Hoehn and Yahr stages of patients with PD. A Markov model with 1-year cycle length and 50-year time horizon was used to assess the cost-effectiveness of add-on exenatide to conventional pharmacotherapy compared to conventional pharmacotherapy alone. All costs were adjusted to the value of the new Taiwanese dollar (NT$) as of the year 2020. One-way sensitivity and probability analyses were performed to test the robustness of the results.

Results

From a societal perspective, the add-on exenatide brought an average of 0.39 quality-adjusted life years (QALYs) gained, and a cost increment of NT$104,744 per person in a 50-year horizon compared to conventional pharmacotherapy. The incremental cost-effectiveness ratio (ICER) was NT$268,333 per QALY gained. As the ICER was less than the gross domestic product per capita (NT$839,558), the add-on exenatide was considered to be very cost-effective in the two models, according to the World Health Organization recommendation. Add-on exenatide had a 96.9% probability of being cost-effective in patients with PD, and a 100% probability of being cost-effective in patients with PD and DM.

Conclusion

Add-on exenatide is cost-effective in PD combined with DM. Considering that DM may be a risk factor for neurodegenerative diseases, exenatide provides both clinical benefits and cost-effectiveness when considering both PD and DM.

Economic cost of diabetes in the Eastern Mediterranean region countries: A meta-analysis

BACKGROUND AND AIMS

Non communicable diseases including diabetes imposes substantial financial burden on households, societies and nations in both developed and developing countries. However, there is no information on the extent of diabetes expenditure in the Eastern Mediterranean Region (EMRO). Therefore, this study aimed to identify the treatment costs of diabetes in this area. To our knowledge, this is the first systematic review on treatment expenditures of diabetes in EMRO countries.

METHODS

A comprehensive literature search was conducted in PUBMED, MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCES databases to find out published manuscripts on treatment cost of diabetes. Information was extracted using data extraction sheets and then the data were imported into STATA software version.11. Mean annual treatment cost of diabetes per patient, annual treatment costs of diabetes per patient by Diabetes Mellitus (DM) complications and finally, cost of chronic diabetes complications per patient were pooled and reported.

RESULTS

After reviewing title, abstract and the full text of identified articles; a total of seven studies were reported appropriate data for this meta-analysis. The pooled annual treatment cost per diabetes patient for EMRO countries was 1150 US$ (95% CI: 595-2221) which was 3358 US$ (95% CI: 2200-5124) in EMRO countries except of Iran compared to 255 US$ (92-708) in Iran. The treatment cost of diabetes was higher in males, insulin-used and in the patient with family history of diabetes. The cost of diabetes was significantly increased with the duration of diabetes (P = 0.001) as well. According to the results, the largest share of costs is related to medication costs. Finally, the pooled average annual treatment cost per patient by diabetes mellitus complications was varied from 2828 US$ in the patients that have cerebrovascular disease complication to 7261 US$ in the patients with Stroke complication.

CONCLUSIONS

This study demonstrated that the annual treatment cost of diabetes is varied within EMRO countries. Qatar and Iran have spent the highest and lowest cost for diabetes, respectively. This may be due to the large socioeconomic differences between countries and special conditions of them such as currency value in the region.

Type 2 diabetes mellitus in Bangladesh: a prevalence based cost-of-illness study

BACKGROUND

The economic burden of type 2 diabetes has not been adequately investigated in many low- and lower middle-income countries, including Bangladesh. The aim of this study was to estimate the cost-of-illness of type 2 diabetes and to find its determinants in Bangladesh.

METHODS

A cross-sectional study was conducted in 2017 to recruit 1253 participants with type 2 diabetes from six diabetes hospitals, providing primary to tertiary health care services, located in the northern and central regions of Bangladesh. A structured questionnaire was used for face-to-face interviewing to collect non-clinical data. Patients' medical records were reviewed for clinical data and hospital records were reviewed for hospitalisation data. Cost was calculated from the patient's perspective using a bottom-up methodology. The direct costs for each patient and indirect costs for each patient and their attendants were calculated. The micro-costing approach was used to calculate direct cost and the human capital approach was used to calculate indirect cost. Median regression analysis was performed to identify the determinants of average annual cost.

RESULTS

Among the participants, 54% were male. The mean (±SD) age was 55.1 ± 12.5 years and duration of diabetes was 10.7 ± 7.7 years. The average annual cost was US$864.7 per patient. Medicine cost accounted for 60.7% of the direct cost followed by a hospitalisation cost of 27.7%. The average annual cost for patients with hospitalisation was 4.2 times higher compared to those without hospitalisation. Being females, use of insulin, longer duration of diabetes, and presence of diabetes complications were significantly related to the average annual cost per patient.

CONCLUSIONS

The cost of diabetes care is considerably high in Bangladesh, and it is primarily driven by the medicine and hospitalisation costs. Optimisation of diabetes management by positive lifestyle changes is urgently required for prevention of comorbidities and complications, which in turn will reduce the cost.

Life Expectancy and Lifetime Health Care Expenditures for Type 1 Diabetes: A Nationwide Longitudinal Cohort of Incident Cases Followed for 14 Years

OBJECTIVES

To assess additional life expectancy (LE), expected years of life lost , and lifetime health care expenditures after type 1 diabetes diagnosis, stratified by sex and age of first diagnosis (early: 0-12 years; late: 13-40 years).

METHODS

A longitudinal cohort of patients with diabetes was constructed from Taiwan's National Health Insurance Research Database of 1999 to 2012. The survival functions for diabetic patients and age- and sex-matched general population were estimated by using a semiparametric extrapolation method with annual life tables. The average monthly health care expenditures were multiplied by the corresponding monthly survival rates and summed to calculate the lifetime health care expenditures. Cox proportional hazard models were constructed to corroborate the effects of sex and age, after being adjusted for comorbidities, complications, and calendar years.

RESULTS

A total of 2386 cases (45% early diagnosis, 49% males) were identified. An additional LE after diabetes diagnosis was 45.12 years, with an estimated 17.63 years of life lost. The predicted total and diabetes-related lifetime costs were $56,939 and $102,140, respectively. Early diagnosed patients had a longer LE and lower health care spending compared with those of late-diagnosed patients. Male patients had a shorter LE and a higher expected years of life lost than the female patients, which corresponded to lower lifetime costs for the former. The Cox model results for overall mortality corroborated these trends.

CONCLUSIONS

Early detection of type 1 diabetes and sex-specific strategies would probably improve long-term health outcomes and save on the cost of diabetes care.

The Economic Costs of Type 2 Diabetes: A Global Systematic Review

BACKGROUND

There has been a widely documented and recognized increase in diabetes prevalence, not only in high-income countries (HICs) but also in low- and middle-income countries (LMICs), over recent decades. The economic burden associated with diabetes, especially in LMICs, is less clear.

OBJECTIVE

We provide a systematic review of the global evidence on the costs of type 2 diabetes. Our review seeks to update and considerably expand the previous major review of the costs of diabetes by capturing the evidence on overall, direct and indirect costs of type 2 diabetes worldwide that has been published since 2001. In addition, we include a body of economic evidence that has hitherto been distinct from the cost-of-illness (COI) work, i.e. studies on the labour market impact of diabetes.

METHODS

We searched PubMed, EMBASE, EconLit and IBSS (without language restrictions) for studies assessing the economic burden of type 2 diabetes published from January 2001 to October 2014. Costs reported in the included studies were converted to international dollars ($) adjusted for 2011 values. Alongside the narrative synthesis and methodological review of the studies, we conduct an exploratory linear regression analysis, examining the factors behind the considerable heterogeneity in existing cost estimates between and within countries.

RESULTS

We identified 86 COI and 23 labour market studies. COI studies varied considerably both in methods and in cost estimates, with most studies not using a control group, though the use of either regression analysis or matching has increased. Direct costs were generally found to be higher than indirect costs. Direct costs ranged from $242 for a study on out-of-pocket expenditures in Mexico to $11,917 for a study on the cost of diabetes in the USA, while indirect costs ranged from $45 for Pakistan to $16,914 for the Bahamas. In LMICs-in stark contrast to HICs-a substantial part of the cost burden was attributed to patients via out-of-pocket treatment costs. Our regression analysis revealed that direct diabetes costs are closely and positively associated with a country's gross domestic product (GDP) per capita, and that the USA stood out as having particularly high costs, even after controlling for GDP per capita. Studies on the labour market impact of diabetes were almost exclusively confined to HICs and found strong adverse effects, particularly for male employment chances. Many of these studies also took into account the possible endogeneity of diabetes, which was not the case for COI studies.

CONCLUSIONS

The reviewed studies indicate a large economic burden of diabetes, most directly affecting patients in LMICs. The magnitude of the cost estimates differs considerably between and within countries, calling for the contextualization of the study results. Scope remains large for adding to the evidence base on labour market effects of diabetes in LMICs. Further, there is a need for future COI studies to incorporate more advanced statistical methods in their analysis to account for possible biases in the estimated costs.

Changes in prevalence of diabetic complications and associated healthcare costs during a 10-year follow-up period among a nationwide diabetic cohort

OBJECTIVE

Long-term health and economic consequences of diabetes mellitus are of significant importance to health policy makers to identify the most efficient interventions for disease managements. However, existing data are mainly from simulation models instead of "real-world" data. The objective of this study was to longitudinally evaluate the changes of prevalence of diabetic complications and associated healthcare costs in a nationally-representative diabetic cohort.

METHODS

We used the 2000-2011 Taiwan's Longitudinal Health Insurance Database (LHID) to conduct a population-based cohort study of 136,372 patients with type 2 diabetes. Diabetic complications of each patient were calculated annually after the cohort entry by the adapted Diabetes Complications Severity Index (aDCSI) score (sum of diabetic complication with severity levels, range 0-13) using diagnostic codes recorded in the LHID. Study subjects were further categorized into six subgroups according to their aDCSI score (0, 1, 2, 3, 4, 5+) at cohort entry. Healthcare utilizations (including outpatient and inpatient visits) as well as direct medical costs for the six subgroups were estimated annually using patient-level data from the LHID.

RESULTS

We found the severity of diabetic complications increased over time, especially for patients with aDCSI score of 2 and above at cohort entry (at 10years of follow-up: aDCSI=0 (cohort entry), 2.37; aDCSI=1, 3.59; aDCSI=2, 4.60; aDCSI=3, 5.14; aDCSI=4, 5.96). There were significant differences in healthcare utilizations and associated medical costs among patients stratified by aDCSI score (e.g. at 1year after cohort entry, mean counts of inpatient visits: 0.14 vs. 1.81 for aDCSI=0 vs.5+). Relatively high healthcare utilizations and associated medical costs in the first year of cohort entry were observed for patients with aDCSI score of 4 and above at cohort entry.

CONCLUSIONS

We provided the important empirical data for patient-level longitudinal changes in diabetic complications and associated healthcare utilization and medical costs among patients with diabetes.

Risk of hospitalization and healthcare cost associated with Diabetes Complication Severity Index in Taiwan's National Health Insurance Research Database

OBJECTIVE

The aim of this study is to test the validity of adapted Diabetes Complication Severity Index (aDCSI) in predicting the risk of hospitalization and healthcare cost in type 2 diabetic patients using a nationally-representative claims database.

STUDY DESIGN

Retrospective cohort study used 4years of claims data from Taiwan's National Health Insurance Research Database (NHIRD).

METHODS

Type 2 diabetic patients who had 4-years of enrollment were identified as study subjects (N=136,372). The aDCSI score (sum of diabetic complication with severity levels, range 0-13) and complication count (sum of diabetic complications, range 0-7) were generated using diagnostic codes for each patient. Poisson model and linear regression model were conducted to predict risk of hospitalization and healthcare costs associated with aDCSI score and count of diabetic complications.

RESULTS

The aDCSI score (risk ratio 1.51 to 10.32 categorically, and 1.41 linearly) and count of diabetic complications (risk ratio 1.56 to 12.20 categorically, and 1.66 linearly) were significantly positively associated with risk of hospitalization. A one-point increase in the aDCSI score was positively associated with increased healthcare costs.

CONCLUSIONS

The performance of aDCSI in predicting risk of hospitalization and healthcare cost in the nationally-representative claims database is similar to those reported in the original study. It may serve as an efficient tool for stratifying type 2 diabetic patients for disease management programs and population-based studies.

Reduced health-related quality of life in body constitutions of yin-xu, and yang-xu, stasis in patients with type 2 diabetes: taichung diabetic body constitution study

Aim. To evaluate how health-related quality of life (HRQOL) and traditional Chinese medicine (TCM) constitutions of Yin-Xu, Yang-Xu, and Stasis are related in type 2 diabetes patients. Method. Seven hundred and five subjects were recruited in 2010 for this study from a Diabetes Shared Care Network in Taiwan. Generic and disease-specific HRQOL were assessed by the short form 36 (SF-36) and the diabetes impact measurement scale (DIMS). Constitutions of Yin-Xu, Yang-Xu, and Stasis were then assessed by the body constitution questionnaire (BCQ), a questionnaire consisting of 44 items that evaluate the physiological state based on subjective symptoms and signs. Results. Estimated effects of the Ying-Xu and Stasis on all scales of the SF-36 were significantly negative, while estimated effects of the Yang-Xu on all scales (except for SF, RE, MH, and MCS) were significantly negative. For DIMS, the estimated effects of the Ying-Xu and Stasis on all scales were significantly negative except for Stasis on well-being, while Yang-Xu has a significantly negative effect only on symptoms. Conclusions. This study demonstrates that TCM constitutions of Yin-Xu, Yang-Xu, and Stasis are closely related to a reduction in HRQOL. These findings support the need for further research into the impact of intervention for TCM constitutions on HRQOL in patients with type 2 diabetes.

Triggering factors of primary care costs in the years following type 2 diabetes diagnosis in Mexico

BACKGROUND AND AIMS

Diabetes represents a high epidemiological and economic burden worldwide. The cost of diabetes care increases slowly during early years, but it accelerates once chronic complications set in. There is evidence that adequate control may delay the onset of complications. Management of diabetes falls almost exclusively into primary care services until chronic complications appear. Therefore, primary care is strategic for reducing the expedited growth of costs. The objective of this study was to identify predictors of primary care costs in patients without complications in the years following diabetes diagnosis.

METHODS

Direct medical costs for primary care were determined from the perspective of public health services provider. Information was obtained from medical records of 764 patients. Microcosting and average cost techniques were combined. A generalized linear regression model was developed including characteristics of patients and facilities. Primary health care costs for different patient profiles were estimated.

RESULTS

The mean annual primary care cost was USD$465.1. Gender was the most important predictor followed by weight status, insulin use, respiratoty infections, glycemic control and dyslipidemia. A gap in costs was observed between genders; women make greater use of resources (42.1% on average). Such differences are reduced with obesity (18.1%), overweight (22.8%), respiratory infection (20.8%) and age >80 years (26.8%). Improving glycemic control shows increasing costs but at decreasing rates.

CONCLUSIONS

Modifiable factors (glycemic control, weight status and comorbidities) drive primary care costs the first 10 years. Those factors had a larger effect in costs for males than in for females.

Economic Burden of Diabetes Mellitus on Patients with Respiratory Failure Requiring Mechanical Ventilation during Hospitalizations

OBJECTIVES

To examine the economic burden of diabetes mellitus (DM) on medical expenditure among patients with respiratory failure (RF) requiring mechanical ventilation during hospitalization.

METHODS

We extracted the data from Taiwan National Health Research Insurance Database for those adult patients on their first hospitalization for RF requiring mechanical ventilation between 2004 and 2010. We examined associations between medical expenditure and the presence of comorbid DM. We performed independent t tests, chi-square tests, and multivariate linear regression analysis to identify factors associated with excess medical expenditure.

RESULTS

Of 347,961 patients hospitalized with first occurrence of RF requiring mechanical ventilation, 123,023 (35.36%) patients were documented to have a previous diagnosis of DM. Patients with RF and DM were sicker and consumed more health care resources than did patients with RF without DM. After adjusting for the specified covariates, mechanically ventilated patients with RF and DM consumed at least US $618 more of total inpatient medical expenditure than did patients with RF without DM. There were statistically significant interactions between age and DM on their total inpatient medical expenditure regardless of discharge status.

CONCLUSIONS

DM was associated with more severe disease status and higher consumption of medical expenditure during hospitalizations among mechanically ventilated patients due to first occurrence of RF in Taiwan. These findings provide scientific evidence to facilitate appropriate resource allocation and formulate programs for higher quality of care in the future in Taiwan and other countries.

The relationship between healthy lifestyle and hospital utilization among adults with diabetes: results from a national cohort in Taiwan

The aim of this study was to investigate whether adopting healthy lifestyle habits, such as engaging in leisure time physical activity (LTPA), adopting recommended dietary patterns, and not smoking, are associated with reduced hospitalizations over 1 year among adults with diabetes. We analyzed data from a national sample of people aged 18 years and above with self-reported physician-diagnosed diabetes (n = 664) through linkage to the 2001 National Health Interview Survey in Taiwan and the 2002 National Health Insurance claims data. Multivariate analysis showed that participants reporting greater than 150 min/wk of moderate-intensity activity had a significantly lower chance for hospitalization (odds ratio = 0.52; 95% confidence interval [CI] = 0.27-0.98), fewer admissions (incidence rate ratio [IRR] = 0.58; 95% CI = 0.33-1.00), and fewer hospital bed days (IRR = 0.42; 95% CI = 0.20-0.92) compared with inactive individuals. Diet control and smoking status did not significantly predict hospital use after controlling for other factors. Our findings indicate that increased LTPA results in reduced hospitalization among adults with diabetes.

Stratifying healthcare costs using the Diabetes Complication Severity Index

OBJECTIVE

We aim to determine whether healthcare costs for patients diagnosed with Type 2 Diabetes Mellitus (T2DM) are associated with the severity of diabetes complications as measured by the Diabetes Complication Severity Index (DCSI).

METHODS

Retrospective cohort analysis was performed on a 2007 primary care cohort of T2DM patients. The DCSI is a 13-point scale, which comprises 7 categories of complications and their severity levels. Healthcare cost data from 2008 and 2009 were used as primary outcome. Inpatient and outpatient costs incurred for services consumed by patients within the provider network were included. Generalized linear model with log-link and gamma distribution was used to predict healthcare costs.

RESULTS

Of the 59,767 T2DM patients, 2977 (5.0%) deaths occurred and 1336 (2.2%) were lost to follow up. Healthcare cost was strongly associated with increase in DCSI score. Compared to patients without complications, those with more complications (higher DCSI score) had an increased risk of higher healthcare costs. Risk ratio (RR) increased from 1.25 (95%CI: 1.19-1.32) for DCSI=1 to 1.61 (1.51-1.72) for DCSI=2; 2.10 (1.91-2.31) for DCSI=3; 2.52 (2.21-2.87) for DCSI=4 and 3.62 (3.09-4.25) for DCSI≥5. As a continuous score, a one-point increase in the DCSI was associated with a cost increase of 27% (95%CI: 1.25-1.29).

CONCLUSION

The DCSI score is a useful tool for predicting direct healthcare costs. The DCSI can be used to triage high-risk patients for more focused secondary prevention interventions at primary care level, in a bid to lower overall healthcare costs.

Cost analysis for efficient management: diabetes treatment at a public district hospital in Thailand

Objective

The study estimated cost of illness from the provider's perspective for diabetic patients who received treatment during the fiscal year 2008 at Waritchaphum Hospital, a 30-bed public district hospital in Sakhon Nakhon province in northeastern Thailand.

Methods

This retrospective, prevalence-based cost-of-illness study looked at 475 randomly selected diabetic patients, identified by the World Health Organization's International Classification of Diseases, 10th revision, codes E10–E14. Data were collected from the hospital financial records and medical records of each participant and were analysed with a stepwise multiple regression.

Key findings

The study found that the average public treatment cost per patient per year was US$94.71 at 2008 prices. Drug cost was the highest cost component (25% of total cost), followed by inpatient cost (24%) and outpatient visit cost (17%). A cost forecasting model showed that length of stay, hospitalization, visits to the provincial hospital, duration of disease and presence of diabetic complications (e.g. diabetic foot complications and nephropathy) were the significant predictor variables (adjusted R2 = 0.689).

Conclusions

According to the fitted model, avoiding nephropathy and foot complications would save US$19 386 and US$39 134 respectively per year. However, these savings are missed savings for the study year and the study hospital only and not projected savings, as that would depend on the number of diabetic patients managed in the year, the ratio of complicated to non-complicated cases and effectiveness of the prevention programmes. Nonetheless, given the high avoidable cost associated with complications of diabetes, healthcare providers in Thailand should focus on initiatives that delay the progression of complications in diabetic patients.

Prevalence of diabetes in patients with bipolar disorder in Taiwan: a population-based national health insurance study

OBJECTIVE

We investigated the prevalence and correlates of diabetes in patients with bipolar disorder in Taiwan.

METHODS

The National Health Research Institute provided a database of 1,000,000 random subjects from which we selected a sample of 766,427 subjects aged 18 years and over. We identified study subjects who had at least one service claim during 2005, with a primary diagnosis of bipolar disorder or with a prescription for treatment of diabetes.

RESULTS

The prevalence of diabetes in patients with bipolar disorder was higher than in the general population (10.77% vs. 5.57%, OR, 2.01; 99% CI, 1.64-2.48). Compared with the general population, patients with bipolar disorder had a higher prevalence of diabetes in all age groups under 60 years; among females and males; among lower insurance amount groups; among those living in the northern, central and southern regions and among residents living in urban and rural areas. Antipsychotic use was associated with a higher prevalence of diabetes in persons with bipolar disorder.

CONCLUSIONS

Patients with bipolar disorder had a higher prevalence of diabetes than the general population. Prevention, early detection and treatment of diabetes are important issues for patients with bipolar disorder.

Improving preventive foot care for diabetic patients participating in group education

BACKGROUND

Diabetic foot care has yet to be enhanced in a universal health-care system in which specialized podiatric medical services are unavailable. This baseline assessment surveyed diabetic patients attending group education to improve current foot-care practices.

METHODS

Of 302 diabetic patients receiving usual outpatient care, 155 received group patient education on general diabetes-related information, which included foot care and an annual checkup by a diabetes association during the previous 2 years, and 147 did not. Patient foot-care behaviors, physician practice patterns, and patient self-perceived foot risk as cross-checked with the neurologic and vascular assessments were investigated by conducting retrospective medical record reviews and structured interviews.

RESULTS

More than half of the patients in both groups reported inappropriate self-care behaviors (eg, walking barefoot and heating or soaking their feet). The percentages of patients receiving documented examinations and referrals for foot problems were low in both groups and were not significantly different. Among at-risk patients, 56% of the diabetes association group but only 30% of the non-diabetes association group perceived themselves to be at risk for future foot problems (P<.01).

CONCLUSIONS

Many diabetic patients were not offered adequate foot-specific information during group lectures, even those with high-risk foot problems. To improve this, combining caregiver and patient education in foot-care practices is important, and systems of networked multidisciplinary professionals are believed to be needed, particularly in delivering customized interventions to at-risk patients based on the initial evaluation.

Prevalence of diabetes in patients with schizophrenia in Taiwan: a population-based National Health Insurance study

OBJECTIVE

We conducted this study to investigate the prevalence and correlates of diabetes in patients with schizophrenia in Taiwan.

METHODS

The National Health Research Institute provided a database of 1,000,000 random subjects for study. We obtained a random sample aged 18 years and over of 766,427 subjects in 2005. Those study subjects who had at least one service claim during this year for either ambulatory or inpatient care, with a primary diagnosis of schizophrenia or with a prescription for treatment of diabetes, were identified.

RESULTS

The prevalence of diabetes in patients with schizophrenia was higher than in the general population (7.90% vs. 5.57%, odds ratio [OR], 1.81; 95% confidence interval [CI], 1.61-2.03). Compared with the general population, patients with schizophrenia revealed a higher prevalence of diabetes in all age groups, except age 70 or more years; among females (10.30% vs. 5.42%, p<0.001), and males (5.93% vs. 5.73%, p<0.001); among all insurance amount groups; among those living in the northern (7.56% vs. 4.89%, p<0.001), central (8.26% vs. 5.61%, p<0.001), southern regions (8.45% vs. 6.62%, p<0.001); and among residents living in urban (8.18% vs. 5.19%, p<0.001) and rural areas (7.99% vs. 6.15%, p<0.001).

CONCLUSIONS

Patients with schizophrenia had a much higher prevalence of diabetes in younger adult age groups and in females than in the general population, a finding that deserves further biological and psychosocial study in the future.

Factors affecting health-care costs and hospitalizations among diabetic patients in Thai public hospitals

OBJECTIVE

The study investigated the factors affecting health-care costs and hospitalizations among diabetic patients in Thai public hospitals.

METHODS

A retrospective study was conducted by using administrative claims data obtained from diabetic patients during October 1, 2002 and September 30, 2003. Dependent variables were total health-care costs and the occurrence of hospitalizations. Independent variables included demographic factors, health-care utilisation, complications, comorbidities, and payment methods. Multivariate statistical analyses were applied.

RESULTS

The results of this study suggested that demographic factors of patients (i.e., age and male sex), payment methods (i.e., capitation, fee-for-service, and out-of-pocket) were significantly associated with higher health-care costs and probability of hospitalization. Patients receiving treatment from teaching hospitals significantly consumed higher health-care costs. In addition, the more health-care utilisation (i.e., occurrence of hospitalization, number of outpatient visit, and insulin utilization), the higher health-care costs the patients significantly had. Diabetic patients taking insulin had significantly higher health-care costs and risk of hospitalization. Furthermore, comorbidities (e.g., hypertension and cancer) and diabetes-related complications (e.g., nephropathy, neuropathy, retinopathy, coronary artery disease, cardiovascular disease, and peripheral vascular disease) were significantly associated with an increase in health-care costs and hospitalization.

CONCLUSION

Factors affecting health-care costs and hospitalizations may help health-care providers intervene to improve patient management and possibly reduce health-care costs in the future.

Trends in the use of antihypertensive drugs by outpatients with diabetes in Taiwan, 1997-2003

PURPOSE

To analyze trends in AHD-use by diabetic outpatients in Taiwan over a 7-year period (1997-2003) and to see whether the trends are consistent with clinical trial outcomes and published guidelines.

METHODS

A cross-sectional survey was implemented using National Health Insurance Research Database between January 1997 and December 2003. Adult outpatients who had diagnoses of diabetes and hypertension and who had concurrent antidiabetic and antihypertensive drug claim were identified. The prescribing trends were described in terms of the prescribing rates and patterns of AHDs in each study year.

RESULTS

Of the AHDs, CCBs were the most widely prescribed class throughout the study period but the prescribing rates declined considerably over the study period. A significant downward trend was also observed for beta-blockers and other classes. Drugs acting on the RAS were the only one class showing a significant increase in prescribing rates with time. The prescribing patterns for monotherapy regimen decreased over time while those for two-, three-, and four or more drug regimens increased over time. Monotherapies maintained with CCBs, beta-blockers, diuretics, and other classes steadily declined but those maintained with drugs acting on the RAS markedly increased.

CONCLUSIONS

The use of drugs acting on the RAS showed a marked increasing trend over the course of the study. Physicians' prescribing patterns for AHD are increasingly involving multi-drug regimens. These findings may imply that management of hypertension in patients with diabetes had a positive trend toward to new clinical trial outcomes and guideline's recommendation.

Resource use among patients with diabetes, diabetic neuropathy, or diabetes with depression

BACKGROUND

Diabetes is often associated with complications and comorbidities. The purpose of this research is to compare medical resources used by patients with the following diagnoses: diabetes mellitus (DM), diabetic neuropathy (DN), and diabetes mellitus combined with comorbid depression (DD).

METHODS

Adult patients who were diagnosed with DM, DN, or DD were included in the study. There were 55,972 patients in the DM cohort, 2,146 in the DN, and 2,379 in the DD. P values for comparisons between the three mutually exclusive cohorts were conducted using the Tukey-Kramer method. Cost comparisons among the cohorts were conducted using a stepwise multivariate regression that controlled for patient characteristics and comorbid conditions.

RESULTS

Individuals in the DM or DN cohorts were generally more likely to use antidiabetic medications than patients in the DD group. Those diagnosed with DN or DD generally used more pain medications than individuals in the DM cohort. The DM cohort had significantly lower diabetes-related total medical costs ($1,297 v $5,125, p < 0.0001) and lower total medical costs ($4,819 v $24,765, p < 0.0001) than the DN cohort. The DM cohort also had significantly lower diabetes-related total medical costs ($1,297 v $3,264, p < 0.0001) as well as significantly lower total medical costs ($4,819 v $19,298, p < 0.0001) than the DD cohort.

CONCLUSION

Results from this study indicated significant differences in demographic characteristics, comorbidities, and medication use among individuals diagnosed with DM, DN, or DD. These differences translated into significant cost differences. Patients diagnosed with DN or DD had higher diabetes-related costs than patients diagnosed with DM.

Prevalence of type 2 diabetes mellitus of Chinese populations in Mainland China, Hong Kong, and Taiwan

This article reviews and describes trends and differences in prevalence of type 2 diabetes mellitus of Chinese populations in Mainland China, Hong Kong and Taiwan based on literatures published in the MEDLINE Advanced database (January 1966-October 2005) in both Chinese and English languages. Chinese populations in Hong Kong and Taiwan have significant higher prevalence rates of diabetes than their Mainland counterparts, with odds ratios 1.5 (95% confidence intervals: 1.4, 1.7) and 2.0 (95% confidence intervals: 1.8, 2.2), respectively in 1995-2003 adjusted for age and diagnostic criteria. Using stratified diagnostic criteria; the odds ratios in Hong Kong and Taiwan were consistently higher than Mainland China for the periods of 1985-1994 and 1995-2003. A large proportion, i.e. 68.6% (95% confidence intervals: 67.4%, 69.7%) of diabetic patients remains undiagnosed in Mainland China as compared to 52.6% (95% confidence intervals: 49.8%, 55.5%) undiagnosed in Hong Kong and Taiwan. The prevalence rates of diabetes and impaired glucose tolerance of the Chinese populations rise in older age groups. In tandem with economic development and change toward lifestyle that is lack of physical activity and rich in high-fat diet, prevalence of diabetes of the Chinese populations are on the rise. If the undiagnosed individuals left uncontrolled, they are subject to higher risks of developing diabetes and its complications. These will increase the burdens of diabetes medically and financially.

Trends in the use of oral antidiabetic drugs by outpatients in Taiwan: 1997-2003

OBJECTIVE

To define the prescribing patterns of oral antidiabetic drugs (OADs) in Taiwan over a 7-year period (1997-2003) and to critically comment on changes observed.

METHODS

A cross-sectional study design was implemented using data from Taiwan's National Health Insurance Research Database between January 1997 and December 2003. Outpatients who were 18 years or older and had at least an OAD claim during the study period were identified. The unit of analysis was each OAD prescription for diabetic outpatient visits. The prescribing trends were described in terms of annual changes in prescribing rates and patterns.

RESULTS

The numbers of OAD prescriptions rose 1.23-fold. The sulfonylurea (SU) class was the most commonly used OAD, but the prescribing rates for this class declined over time. The biguanide (BG) class was the second most frequently prescribed OAD class and its prescribing rate initially increased, peaked in 2000, and then substantially decreased. The largest increase in prescribing was for acarbose use. The prescribing rates of two new classes of OAD, meglitinide (MG) and thiazolidinedione (TZD), also significantly increased within a short period of time. A trend towards combination therapy was observed away from monotherapy. The SU class was the most commonly prescribed as monotherapy. SU plus BG was the most commonly prescribed dual therapy. Triple oral therapy showed a significant ninefold increase.

CONCLUSION

The prescribing rates of OADs are shifting from the older OADs (i.e. SUs) to newer OADs [i.e. alpha-glucosidase inhibitor (AGI), MGs, and TZDs]. The prescribing patterns of OADs are moving toward combination therapy, especially triple oral therapy.

Professional accountability for diabetes care in Taiwan

This study examined the performance of diabetes care measures in Taiwan and evaluated the influencing factors for professional accountability. We analyzed the year 2001 claims data from National Health Insurance (NHI) program in Taipei Branch. Professional accountability for diabetes care was measured by the adherence for laboratory monitor, either from patient- or hospital-viewpoint. Identifying the major care unit for each patient, a multiple logistic regression model was used to further assess the mixed effects of patient and hospital characteristics. The percentage of patients ever received measures in the year for plasma glucose, A(1C), urinalysis, renal function test, lipid profile, liver function test, and eye ground was 76.3, 42.7, 40.2, 59.7, 59.2, 53.2, and 16.8% respectively. About 19.2% patients never received any one of the measures. Patients with hypoglycemic, anti-hypertensive or anti-hyperlipidemic agents, hospitalization, emergency service visit and frequent visits were more likely to receive exams. Hospitals with different levels, ownerships, locales or qualifications as diabetes care institutions presented different accountability for diabetes care measures. After regression, counts of visits and levels of hospitals had persistently effects on all the measures. Our analysis revealed sub-optimal diabetes care in Taiwan and concluded the importance of enhancing care quality from primary settings.