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Wang S, Guo Y, Maitland E, Nicholas S, Sun J, Leng A. The Economic Burden of Hospital Costs on Families With Type 1 Diabetes Mellitus Children: The Role of Medical Insurance in Shandong Province, China. Front Public Health 2022; 10:853306. [PMID: 35602147 PMCID: PMC9121097 DOI: 10.3389/fpubh.2022.853306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study estimates the economic burden imposed on families by comparing the hospitalization costs of T1DM children with and without medical insurance in Shandong province. Methods Our data comprised 1,348 T1DM inpatient records of patients aged 18 years or younger from the hospitalization information system of 297 general hospitals in 6 urban districts of Shandong Province. Descriptive statistics are presented and regression analyses were conducted to explore the factors associated with hospitalization costs. Results Children with medical insurance had on average total hospitalization expenditures of RMB5,833.48 (US$824.02) and a hospitalization stay of 7.49 days, compared with the children without medical insurance who had lower hospitalization expenditures of RMB4,021.45 (US$568.06) and an average stay of 6.05 days. Out-of-pocket expenses for insured children were RMB3,036.22 (US$428.89), which is significantly lower than that of the uninsured children (P < 0.01). Out-of-pocket (OOP) expenditures accounted for 6% of the annual household income of insured middle-income families, but rose to a significant 25% of the annual income for low-income families. These OOP expenditures imposed a heavy economic burden on families, with some families experiencing long-term financial distress. Both insured and uninsured families, especially low-income families, could be tipped into poverty by hospitalization costs. Conclusion Hospitalization costs imposed a significant economic burden on families with children with T1DM, especially low-income insured and uninsured families. The significantly higher hospitalization expenses of insured T1DM children, such as longer hospitalization stays, more expensive treatments and more drugs, may reflect both excess treatment demands by parents and over-servicing by hospitals; lower OOP expenses for uninsured children may reflect uninsured children from low-income families forgoing appropriate medical treatment. Hospital insurance reform is recommended.
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Affiliation(s)
- Siyuan Wang
- Faculty of Business and Economics, University of Melbourne, Melbourne, VIC, Australia
| | - Yawei Guo
- Taiyuan Municipal Health Commission, Taiyuan, China
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, United Kingdom
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia
- Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, Jinan, China
| | - Anli Leng
- School of Political Science and Public Administration, Shandong University, Qingdao, China
- Center for Health Preferences Research, Shandong University, Jinan, China
- *Correspondence: Anli Leng
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Khaing Oo WW, Riewpaiboon A, Youngkong S, Ko K. How Economic Analysis Increases the Awareness of Clinical Services: A Case of Diabetes Mellitus at a Teaching Hospital in Myanmar. Value Health Reg Issues 2021; 29:21-27. [PMID: 34800825 DOI: 10.1016/j.vhri.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/29/2021] [Accepted: 09/06/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Myanmar faces a growing epidemic of type 2 diabetes mellitus, which has significant impact on the individual health and health service system; nevertheless, reliable cost estimate for treating diabetes is still unknown. Therefore, this study aimed to explore the treatment cost of hospitalization by type 2 diabetes mellitus and the association of complications and comorbidities with the treatment cost. METHODS The retrospective incidence-based cost of illness analysis was performed at the diabetes ward of 800-bed teaching hospital in Yangon, Myanmar. The data were retrieved from hospital financial reports and patient's medical records for the fiscal year 2017 to 2018. Data was analyzed by using descriptive statistics and multivariate statistics. One-way sensitivity analysis was used to assess the uncertainty of input parameters. RESULTS This study involved 87 inpatients with type 2 diabetes mellitus with an average length of stay of 16.1 ± 12.6 days. Of the study sample, 67% had complications whereas 74% had comorbidities. The average treatment cost per admission was $718.7 (equal to 58% of gross domestic product - GDP per capita) at 2018 prices. Based on the multiple regression analysis, cost savings per admission were $276.5, $307.3, and $319.5 from preventing foot ulcer, nephropathy, and retinopathy, respectively. CONCLUSIONS This study found that the treatment of diabetes is costly because of its preventable health consequences. Better disease management to prevent complications results in considerable cost savings. This quantitative evidence would increase awareness in health service system.
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Affiliation(s)
- Wah Wah Khaing Oo
- Master of Science Program in Social, Economic and Administrative Pharmacy, Mahidol University, Bangkok, Thailand
| | - Arthorn Riewpaiboon
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Mahidol University, Bangkok, Thailand.
| | - Sitaporn Youngkong
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Ko Ko
- Diabetes and Endocrinology Department, University of Medicine 2, Yangon, Myanmar
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Qiu M, Huang S, Luo C, Wu Z, Liang B, Huang H, Ci Z, Zhang D, Han L, Lin J. Pharmacological and clinical application of heparin progress: An essential drug for modern medicine. Biomed Pharmacother 2021; 139:111561. [PMID: 33848775 DOI: 10.1016/j.biopha.2021.111561] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/20/2021] [Accepted: 03/31/2021] [Indexed: 12/22/2022] Open
Abstract
Heparin is the earliest and most widely used anticoagulant and antithrombotic drug that is still used in a variety of clinical indications. Since it was discovered in 1916, after more than a century of repeated exploration, heparin has not been replaced by other drugs, but a great progress has been made in its basic research and clinical application. Besides anticoagulant and antithrombotic effects, heparin also has antitumor, anti-inflammatory, antiviral, and other pharmacological activities. It is widely used clinically in cardiovascular and cerebrovascular diseases, lung diseases, kidney diseases, cancer, etc., as the first anticoagulant medicine in COVID-19 exerts anticoagulant, anti-inflammatory and antiviral effects. At the same time, however, it also leads to a lot of adverse reactions, such as bleeding, thrombocytopenia, elevated transaminase, allergic reactions, and others. This article comprehensively reviews the modern research progress of heparin compounds; discusses the structure, preparation, and adverse reactions of heparin; emphasizes the pharmacological activity and clinical application of heparin; reveals the possible mechanism of the therapeutic effect of heparin in related clinical applications; provides evidence support for the clinical application of heparin; and hints on the significance of exploring the wider application fields of heparin.
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Affiliation(s)
- Min Qiu
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Shengjie Huang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Chuanhong Luo
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Zhenfeng Wu
- Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, PR China
| | - Binzhu Liang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Haozhou Huang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Zhimin Ci
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Dingkun Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China
| | - Li Han
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, PR China.
| | - Junzhi Lin
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, PR China.
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Tao Z, Huiling L, Wenwen W, Xia Y. GA-SVM based feature selection and parameter optimization in hospitalization expense modeling. Appl Soft Comput 2019. [DOI: 10.1016/j.asoc.2018.11.001] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Einarson TR, Acs A, Ludwig C, Panton UH. Economic Burden of Cardiovascular Disease in Type 2 Diabetes: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:881-890. [PMID: 30005761 DOI: 10.1016/j.jval.2017.12.019] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/08/2017] [Accepted: 12/06/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) constitute major comorbidities in type 2 diabetes mellitus (T2DM), contributing substantially to treatment costs for T2DM. An updated overview of the economic burden of CVD in T2DM has not been presented to date. OBJECTIVE To systematically review published articles describing the costs associated with treating CVD in people with T2DM. METHODS Two reviewers searched MEDLINE, Embase, and abstracts from scientific meetings to identify original research published between 2007 and 2017, with no restrictions on language. Studies reporting direct costs at either a macro level (e.g., burden of illness for a country) or a micro level (e.g., cost incurred by one patient) were included. Extracted costs were inflated to 2016 values using local consumer price indexes, converted into US dollars, and presented as cost per patient per year. RESULTS Of 81 identified articles, 24 were accepted for analysis, of which 14 were full articles and 10 abstracts. Cardiovascular comorbidities in patients with T2DM incurred a significant burden at both the population and patient levels. From a population level, CVD costs contributed between 20% and 49% of the total direct costs of treating T2DM. The median annual costs per patient for CVD, coronary artery disease, heart failure, and stroke were, respectively, 112%, 107%, 59%, and 322% higher compared with those for T2DM patients without CVD. On average, treating patients with CVD and T2DM resulted in a cost increase ranging from $3418 to $9705 compared with treating patients with T2DM alone. CONCLUSIONS Globally, CVD has a substantial impact on direct medical costs of T2DM at both the patient and population levels.
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Affiliation(s)
- Thomas R Einarson
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Shi J, Wang Y, Cheng W, Shao H, Shi L. Direct health care costs associated with obesity in Chinese population in 2011. J Diabetes Complications 2017; 31:523-528. [PMID: 27908605 DOI: 10.1016/j.jdiacomp.2016.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 11/27/2022]
Abstract
AIMS Overweight and obesity are established major risk factors for type 2 diabetes, and major public health concerns in China. This study aims to assess the economic burden associated with overweight and obesity in the Chinese population ages 45 and older. METHODS The Chinese Health and Retirement Longitudinal Study (CHARLS) in 2011 included 13,323 respondents of ages 45 and older living in 450 rural and urban communities across China. Demographic information, height, weight, direct health care costs for outpatient visits, hospitalization, and medications for self-care were extracted from the CHARLS database. Health Care costs were calculated in 2011 Chinese currency. The body mass index (BMI) was used to categorize underweight, normal weight, overweight, and obese populations. Descriptive analyses and a two-part regression model were performed to investigate the association of BMI with health care costs. To account for non-normality of the cost data, we applied a non-parametric bootstrap approach using the percentile method to estimate the 95% confidence intervals (95% CIs). RESULTS Overweight and obese groups had significantly higher total direct health care costs (RMB 2246.4, RMB 2050.7, respectively) as compared with the normal-weight group (RMB 1886.0). When controlling for demographic characteristics, overweight and obese adults were 15.0% and 35.9% more likely to incur total health care costs, and obese individuals had 14.2% higher total health care costs compared with the normal-weight group. CONCLUSIONS Compared with the normal-weight counterparts, the annual total direct health care costs were significantly higher among obese adults in China.
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Affiliation(s)
- Jingcheng Shi
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China, 410078.
| | - Yao Wang
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA, 70112.
| | - Wenwei Cheng
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China, 410078.
| | - Hui Shao
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA, 70112.
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA, 70112.
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Fisher K, Griffith L, Gruneir A, Panjwani D, Gandhi S, Sheng LL, Gafni A, Chris P, Markle-Reid M, Ploeg J. Comorbidity and its relationship with health service use and cost in community-living older adults with diabetes: A population-based study in Ontario, Canada. Diabetes Res Clin Pract 2016; 122:113-123. [PMID: 27833049 DOI: 10.1016/j.diabres.2016.10.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 07/29/2016] [Accepted: 10/11/2016] [Indexed: 11/25/2022]
Abstract
AIMS This study describes the comorbid conditions in Canadian, community-dwelling older adults with diabetes and the association between the number of comorbidities and health service use and costs. METHODS This retrospective cohort study used multiple linked administrative data to determine 5-year health service utilization in a population-based cohort of community-living individuals aged 66 and over with a diabetes diagnosis as of April 1, 2008 (baseline). Utilization included physician visits, emergency department visits, hospitalizations, and home care services. RESULTS There were 376,421 cohort members at baseline, almost all (95%) of which had at least one comorbidity and half (46%) had 3 or more. The most common comorbidities were hypertension (83%) and arthritis (61%). Service use and associated costs consistently increased as the number of comorbidities increased across all services and follow-up years. Conditions generally regarded as nondiabetes-related were the main driver of service use. Over time, use of most services declined for people with the highest level of comorbidity (3+). Hospitalizations and emergency department visits represented the largest share of costs for those with the highest level of comorbidity (3+), whereas physician visits were the main costs for those with fewer comorbidities. CONCLUSIONS Comorbidities in community-living older adults with diabetes are common and associated with a high level of health service use and costs. Accordingly, it is important to use a multiple chronic conditions (not single-disease) framework to develop coordinated, comprehensive and patient-centred programs for older adults with diabetes so that all their needs are incorporated into care planning.
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Affiliation(s)
- Kathryn Fisher
- School of Nursing, McMaster University, 1280 Main Street West, Health Sciences Centre Room, Hamilton, Ontario L8S 4K1, Canada.
| | - Lauren Griffith
- Department of Clinical Epidemiology and Biostatistics, McMaster University, McMaster Innovation Park, 175 Longwood Road South, Hamilton, ON L8P 0A1, Canada.
| | - Andrea Gruneir
- Department of Family Medicine, 6-40 University of Alberta, 6-10 University Terrace, Edmonton, AB T6G 2T4, Canada.
| | - Dilzayn Panjwani
- Women's College Research Institute, Women's College Hospital, 790 Bay Street, 7th Floor, Toronto, ON M5G 1N8, Canada.
| | - Sima Gandhi
- Institute for Clinical Evaluative Sciences (ICES), 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
| | - Li Lisa Sheng
- Institute for Clinical Evaluative Sciences (ICES), 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
| | - Amiram Gafni
- Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Room CRL-208, Hamilton, Ontario L8S 4K1, Canada,.
| | - Patterson Chris
- Department of Medicine, McMaster University, 1280 Main Street West, Health Sciences Centre, Room 3N25B, Hamilton, Ontario L8S 4K, Canada.
| | - Maureen Markle-Reid
- School of Nursing, McMaster University, 1280 Main Street West, Health Sciences Centre Room, Hamilton, Ontario L8S 4K1, Canada.
| | - Jenny Ploeg
- School of Nursing, McMaster University, 1280 Main Street West, Health Sciences Centre Room, Hamilton, Ontario L8S 4K1, Canada.
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Becerra MB, Allen NL, Becerra BJ. Food insecurity and low self-efficacy are associated with increased healthcare utilization among adults with type II diabetes mellitus. J Diabetes Complications 2016; 30:1488-1493. [PMID: 27474705 DOI: 10.1016/j.jdiacomp.2016.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/03/2016] [Accepted: 07/15/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Food insecurity has been shown to negatively impact health outcomes, disease management and hospitalizations. Despite the increasing burden of type II diabetes mellitus (T2DM) in the United States, little research exists on the role of food insecurity and its association to T2DM-related healthcare utilization. The purpose of our study was to address such a gap in the literature by evaluating the role of food insecurity and T2DM-related past 12-month hospitalization or emergency department (ED) admission among adults with healthcare professional diagnosed T2DM. METHODS We utilized the California Health Interview Survey (CHIS), 2009, 2011/2012 data to select CHIS participants who were aged 18 or older and reported doctor diagnosis of T2DM; resulting in a total of 8252 participants. Food insecurity was defined as: living at or above 200% federal poverty level (FPL), living below 200% FPL but food secure, living below 200% FPL and food insecure. A secondary exposure variable of interest was self-efficacy, based on the CHIS-provided variable of confidence to manage T2DM. All analyses were survey weighted with alpha less than .05 noting significance. RESULTS Those with low food security (12.96%) and low-self efficacy (15.14%), reported significantly higher prevalence of T2DM-related healthcare utilization, as compared to their counterparts. Both living with low food security and having low self-efficacy were also associated with over two-fold increase in healthcare utilization. CONCLUSION Our results demonstrate the cumulative need for community-based resources to improve the continuum of care and ensure that such at-risk populations have adequate resources for disease management.
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Affiliation(s)
- Monideepa B Becerra
- Department of Health Science and Human Ecology, California State University, San Bernardino, CA, United States.
| | | | - Benjamin J Becerra
- School of Allied Health Professions, Loma Linda University, Loma Linda, CA, United States
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Fukuda H, Ikeda S, Shiroiwa T, Fukuda T. The Effects of Diagnostic Definitions in Claims Data on Healthcare Cost Estimates: Evidence from a Large-Scale Panel Data Analysis of Diabetes Care in Japan. PHARMACOECONOMICS 2016; 34:1005-1014. [PMID: 27016372 DOI: 10.1007/s40273-016-0402-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Inaccurate estimates of diabetes-related healthcare costs can undermine the efficiency of resource allocation for diabetes care. The quantification of these costs using claims data may be affected by the method for defining diagnoses. OBJECTIVES The aims were to use panel data analysis to estimate diabetes-related healthcare costs and to comparatively evaluate the effects of diagnostic definitions on cost estimates. RESEARCH DESIGN Monthly panel data analysis of Japanese claims data. SUBJECTS The study included a maximum of 141,673 patients with type 2 diabetes who received treatment between 2005 and 2013. MEASURES Additional healthcare costs associated with diabetes and diabetes-related complications were estimated for various diagnostic definition methods using fixed-effects panel data regression models. RESULTS The average follow-up period per patient ranged from 49.4 to 52.3 months. The number of patients identified as having type 2 diabetes varied widely among the diagnostic definition methods, ranging from 14,743 patients to 141,673 patients. The fixed-effects models showed that the additional costs per patient per month associated with diabetes ranged from US$180 [95 % confidence interval (CI) 178-181] to US$223 (95 % CI 221-224). When the diagnostic definition excluded rule-out diagnoses, the diabetes-related complications associated with higher additional healthcare costs were ischemic heart disease with surgery (US$13,595; 95 % CI 13,568-13,622), neuropathy/extremity disease with surgery (US$4594; 95 % CI 3979-5208), and diabetic nephropathy with dialysis (US$3689; 95 % CI 3667-3711). CONCLUSIONS Diabetes-related healthcare costs are sensitive to diagnostic definition methods. Determining appropriate diagnostic definitions can further advance healthcare cost research for diabetes and its applications in healthcare policies.
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Affiliation(s)
- Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Shunya Ikeda
- School of Pharmacy, International University of Health and Welfare, 2600-1, Kitakanemaru, Ōtawara, Tochigi, 324-8501, Japan
| | - Takeru Shiroiwa
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6, Minami, Wako, Saitama, 351-0197, Japan
| | - Takashi Fukuda
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6, Minami, Wako, Saitama, 351-0197, Japan
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Laberge M, Kone Pefoyo AJ. Assessing the Effectiveness of Policies to Reduce Diabetes Hospitalizations Before and After the Reforms of Physician Payment and Primary Care Organization in British Columbia and Alberta. Can J Diabetes 2016; 40:406-410. [PMID: 27062111 DOI: 10.1016/j.jcjd.2016.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/06/2016] [Accepted: 02/21/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Diabetes is one of the most common chronic conditions in Canada. Appropriate care management, particularly in primary care settings, has been demonstrated to improve the outcomes of people with this condition. Policies have been implemented to support primary care providers in providing appropriate diabetes management. This study aimed to evaluate whether policy changes related to improving care have impacted diabetes hospitalizations in British Columbia and Alberta, Canada. METHODS This study used a before-and-after evaluation design based on longitudinal administrative data including physicians' claims and hospitalizations from 1998-1999 to 2009-2010. We performed ordinary least squares regressions to assess the variations in diabetes hospitalization rates following the implementation of policies in primary care settings in each province. RESULTS Diabetes-related hospitalization rates have been decreasing since 1998 and continued to decrease after the reforms in both provinces. In 1998, the adjusted hospitalization rate for diabetes was 2.9% in Alberta and 1.7% in British Columbia compared to, respectively, 1.1% and 0.8% in 2009. Regression results suggest that the changes in policy in 2003 have had limited impact on outcomes for those with diabetes. CONCLUSIONS The hospitalization rates were already declining in both provinces over time, before and after the reform, so it is challenging to disentangle the decrease that could be attributable to policy changes. More research is needed to better understand the impact of changes in primary care on outcomes such as hospitalizations for diabetes.
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Affiliation(s)
- Maude Laberge
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA.
| | - Anna J Kone Pefoyo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dala Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Gao N, Yuan Z, Tang X, Zhou X, Zhao M, Liu L, Ji J, Xue F, Ning G, Zhao J, Zhang H, Gao L. Prevalence of CHD-related metabolic comorbidity of diabetes mellitus in Northern Chinese adults: the REACTION study. J Diabetes Complications 2016; 30:199-205. [PMID: 26718938 DOI: 10.1016/j.jdiacomp.2015.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/09/2015] [Accepted: 11/23/2015] [Indexed: 01/19/2023]
Abstract
AIM To gain more precise understanding of the epidemiology of comorbidities with diabetes and to clarify the correlation with coronary heart disease (CHD) in Chinese population. METHODS Based on REACTION study, 18,696 participants aged over 40 years were included in the cross-sectional analysis. Prevalence and patterns of comorbid diseases were demonstrated, and their impact on CHD was also analyzed by logistic regression. RESULTS Diabetes was more prevalent in patients with older age and lower education level, with relatively low awareness (36.3%), treatment (27.9%) and control (34.7%) rate. The proportion of diabetics with additional condition was 88.8%; 53.2% had more than two comorbidities. Compared with patients with comorbidities, diabetics only had the highest controlled HbA1c rate (37.9%). Dyslipidemia (71.97%) was the most common comorbidity, followed by hypertension (58.19%), and hypothyroidism (21.24%). A strong gradient existed between the number of comorbidities and CHD versus "diabetes only" group; the odds ratio was 1.38, 2.48 and 3.01 for diabetics with one, two and three additional diseases, respectively. CONCLUSIONS Low glycemic control and high prevalence of diabetes comorbidities are common in China, which increases the risk of CHD. Full-scale and individualized guidelines for diabetics should be planned.
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Affiliation(s)
- Nannan Gao
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
| | - Zhongshang Yuan
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China; Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong,250021, China
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu,730000, China
| | - Xiaoming Zhou
- Scientific Center, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Meng Zhao
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
| | - Lu Liu
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
| | - Jiadong Ji
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong,250021, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong,250021, China
| | - Guang Ning
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jiajun Zhao
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
| | - Haiqing Zhang
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China.
| | - Ling Gao
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong University, Shandong Clinical Medical Center of Endocrinology and Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China; Scientific Center, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China.
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Fu H, Curtis BH, Xie W, Festa A, Schuster DP, Kendall DM. Frequency and causes of hospitalization in older compared to younger adults with type 2 diabetes in the United States: a retrospective, claims-based analysis. J Diabetes Complications 2014; 28:477-81. [PMID: 24636762 DOI: 10.1016/j.jdiacomp.2014.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 01/15/2023]
Abstract
AIMS This study assessed the frequency and most common causes of hospitalization in older compared to younger adults with type 2 diabetes mellitus (T2DM) in the US. METHODS A retrospective study utilizing data from a nationally representative insurance claim database included patients who were diagnosed or treated for diabetes during or prior to the defined study period and who experienced hospitalization with or without re-hospitalization. RESULTS Among 887,182 patients with T2DM, 31% were ≥ 65 years old and nearly 1 in 4 (23.5%) were hospitalized during the observation period. Only 2.3% of first hospitalizations were determined to be diabetes-related, and these events were most commonly associated with a history of pre-study hospitalization and increasing age. Hypoglycemia was a common cause for T2DM-related hospitalizations (22.9%), and older patients demonstrated a higher proportion of hypoglycemia-related hospitalizations (age ≥ 65 years: 38.3% vs. age < 65 years: 11.4%). Survival analysis predicting readmission within 6 months after first hospitalization showed that primary factors associated with first readmissions were history of prior hospitalization, malignancy, insulin use, and presence of pre-existing liver or renal disease. CONCLUSIONS Hospitalization is common in patients with diagnosed diabetes, and nearly 1 in 4 diabetes-related hospital admissions were due to hypoglycemia. While the overall rate of hypoglycemia-associated admission was low, the age-specific rate was nearly 2.5-fold higher in older adults (≥ 65 years), affirming the need to carefully assess the potential benefit/risk of diabetes medications in those ≥ 65 years of age.
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Affiliation(s)
- Haoda Fu
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN
| | | | - Wenting Xie
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN
| | | | - Dara P Schuster
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN
| | - David M Kendall
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN.
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Giorda CB, Manicardi V, Diago Cabezudo J. The impact of diabetes mellitus on healthcare costs in Italy. Expert Rev Pharmacoecon Outcomes Res 2014; 11:709-19. [DOI: 10.1586/erp.11.78] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Huber CA, Diem P, Schwenkglenks M, Rapold R, Reich O. Estimating the prevalence of comorbid conditions and their effect on health care costs in patients with diabetes mellitus in Switzerland. Diabetes Metab Syndr Obes 2014; 7:455-65. [PMID: 25336981 PMCID: PMC4199853 DOI: 10.2147/dmso.s69520] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Estimating the prevalence of comorbidities and their associated costs in patients with diabetes is fundamental to optimizing health care management. This study assesses the prevalence and health care costs of comorbid conditions among patients with diabetes compared with patients without diabetes. Distinguishing potentially diabetes- and nondiabetes-related comorbidities in patients with diabetes, we also determined the most frequent chronic conditions and estimated their effect on costs across different health care settings in Switzerland. METHODS Using health care claims data from 2011, we calculated the prevalence and average health care costs of comorbidities among patients with and without diabetes in inpatient and outpatient settings. Patients with diabetes and comorbid conditions were identified using pharmacy-based cost groups. Generalized linear models with negative binomial distribution were used to analyze the effect of comorbidities on health care costs. RESULTS A total of 932,612 persons, including 50,751 patients with diabetes, were enrolled. The most frequent potentially diabetes- and nondiabetes-related comorbidities in patients older than 64 years were cardiovascular diseases (91%), rheumatologic conditions (55%), and hyperlipidemia (53%). The mean total health care costs for diabetes patients varied substantially by comorbidity status (US$3,203-$14,223). Patients with diabetes and more than two comorbidities incurred US$10,584 higher total costs than patients without comorbidity. Costs were significantly higher in patients with diabetes and comorbid cardiovascular disease (US$4,788), hyperlipidemia (US$2,163), hyperacidity disorders (US$8,753), and pain (US$8,324) compared with in those without the given disease. CONCLUSION Comorbidities in patients with diabetes are highly prevalent and have substantial consequences for medical expenditures. Interestingly, hyperacidity disorders and pain were the most costly conditions. Our findings highlight the importance of developing strategies that meet the needs of patients with diabetes and comorbidities. Integrated diabetes care such as used in the Chronic Care Model may represent a useful strategy.
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Affiliation(s)
- Carola A Huber
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
- Correspondence: Carola A Huber, Department of Health Sciences, Helsana Group, PO Box 8081 Zürich, Switzerland, Tel +41 43 340 6341, Fax +41 43 340 04 34, Email
| | - Peter Diem
- Department of Endocrinology, Diabetes and Clinical Nutrition, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Roland Rapold
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
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Keskek SO, Kirim S, Yanmaz N, Keskek NS, Ortoglu G, Canataroglu A. Direct medical cost of type 1 and type 2 diabetes in Turkey. Int J Diabetes Dev Ctries 2013. [DOI: 10.1007/s13410-013-0159-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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O'Shea M, Teeling M, Bennett K. The prevalence and ingredient cost of chronic comorbidity in the Irish elderly population with medication treated type 2 diabetes: a retrospective cross-sectional study using a national pharmacy claims database. BMC Health Serv Res 2013; 13:23. [PMID: 23324517 PMCID: PMC3554499 DOI: 10.1186/1472-6963-13-23] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 01/10/2013] [Indexed: 02/04/2023] Open
Abstract
Background Comorbidity in patients with diabetes is associated with poorer health and increased cost. The aim of this study was to investigate the prevalence and ingredient cost of comorbidity in patients ≥ 65 years with and without medication treated type 2 diabetes using a national pharmacy claims database. Methods The Irish Health Service Executive Primary Care Reimbursement Service pharmacy claims database, which includes all prescribing to individuals covered by the General Medical Services scheme, was used to identify the study population (≥ 65 years). Patients with medication treated type 2 diabetes (T2DM) were identified using the prescription of oral anti-hyperglycaemic agents alone or in combination with insulin as a proxy for disease diagnosis. The prevalence and ingredient prescribing cost of treated chronic comorbidity in the study population with and without medication treated T2DM were ascertained using a modified version of the RxRiskV index, a prescription based comorbidity index. The association between T2DM and comorbid conditions was assessed using logistic regression adjusting for age and sex. Bootstrapping was used to ascertain the mean annual ingredient cost of treated comorbidity. Statistical significance at p < 0.05 was assumed. Results In 2010, 43165 of 445180 GMS eligible individuals (9.7%) were identified as having received medication for T2DM. The median number of comorbid conditions was significantly higher in those with T2DM compared to without (median 5 vs. 3 respectively; p < 0.001). Individuals with T2DM were more likely to have ≥ 5 comorbidities when compared to those without (OR = 2.82, 95% CI = 2.76-2.88, p < 0.0001). The mean annual ingredient cost for comorbidity was higher in the study population with T2DM (€1238.67, 95% CI = €1238.20 - €1239.14) compared to those without the condition (€799.28, 95% CI = €799.14 - € 799.41). Conclusions Individuals with T2DM were more likely to have a higher number of treated comorbid conditions than those without and this was associated with higher ingredient costs. This has important policy and economic consequences for the planning and provision of future health services in Ireland, given the expected increase in T2DM and other chronic conditions.
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Affiliation(s)
- Miriam O'Shea
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, James's Street, Dublin 8, Ireland.
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He M, Ma J, Wang D, Yu X. Costs for hospitalized patients with diabetes mellitus in China. Asia Pac J Public Health 2012; 27:NP925-35. [PMID: 22743857 DOI: 10.1177/1010539512448813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To evaluate direct hospitalization costs attributable to diabetes and their determinants in a tertiary care hospital in mainland China between 2007 and 2008. METHODS A retrospective study of the hospitalization expenses for 489 inpatients with diabetes from June 2007 to July 2008 was conducted. All related cost components were defined and valued at the most detailed levels. RESULTS Median cost was 5307.8 RMB (range 3672.8-8193.2 RMB). The costs for biochemical tests (28%), pharmacy (26%), and therapies and supplies (21%) were the top 3, about 75% in total expenses. The expenses for the antihyperglycemic treatment alone accounted for 27.6% of total hospitalization expenses. Insulin treatment (P < .001), complication number (P < .001), length of hospitalization (P < .001), diabetes duration (P = .023), and hemoglobin A1C (P = .040) were the main factors affecting costs. CONCLUSIONS Antihyperglycemic treatment expenses represent a minority of total costs; major costs are due to treatment of complications.
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Affiliation(s)
- Mingjuan He
- Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Jingdong Ma
- Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Daowen Wang
- Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Xuefeng Yu
- Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
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Pérez Pérez A, Gómez Huelgas R, Alvarez Guisasola F, García Alegría J, Mediavilla Bravo JJ, Menéndez Torre E. [Consensus document on the management after hospital discharge of patient with hyperglycaemia]. Med Clin (Barc) 2012; 138:666.e1-666.e10. [PMID: 22503128 DOI: 10.1016/j.medcli.2012.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 02/13/2012] [Accepted: 02/16/2012] [Indexed: 02/03/2023]
Abstract
The present document intends to adapt the general recommendations set up in a consensus to elaborate the hospital discharge report in medical specialties to the specific needs of the hospitalized diabetic population. Diabetes is an illness with a very high health cost, being the global risk of death in people with diabetes almost double than in non-diabetes people, justifying the fact that diabetes constitutes one of the most frequent diagnoses in hospitalized patients and the growing interest upon hyperglycaemia management during hospitalization and at discharge. To set up an adequate treatment plan at discharge suitable for each patient, the most important elements to take into account are the etiology and prior hyperglycaemia treatment, the patient's clinical situation and the degree of glycaemia control. Due to instability of glycaemia control, it is also needed to anticipate the educational needs for each patient, as well as to set up the monitoring schedule and follow-up at discharge, and an adequate treatment plan at discharge.
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Lkhagva D, Kuwabara K, Matsuda S, Gao Y, Babazono A. Assessing the impact of diabetes-related comorbidities and care on the hospitalization costs for patients with diabetes mellitus in Japan. J Diabetes Complications 2012; 26:129-36. [PMID: 22409964 DOI: 10.1016/j.jdiacomp.2011.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 09/06/2011] [Accepted: 12/21/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Because diabetes mellitus (DM) has been highlighted in several healthcare sectors, variations in the case mix of DM should be evaluated to promote effective disease management. Using a Japanese administrative database (2003), we investigated the impact of DM-related comorbidities and of their relevant care processes on healthcare costs incurred during hospitalization. METHODS Of 283,771 hospital admissions across 174 acute care hospitals, 27,853 patients with DM were analyzed. The following variables were analyzed according to age (<65 or ≥65 years), the presence of comorbidities, demographic characteristics, procedure-related complications, insulin use, surgical procedures (percutaneous minimally invasive intervention, hemodialysis, ventilation, and rehabilitation), length of stay (LOS), and total charge (TC; US$1=Y90). Multivariate analyses were applied to investigate the effects of DM-related complications and care processes associated with DM on TC. RESULTS The mortality and procedure-related complication rates were 2.1% and 2.7%, respectively. There were significant differences in the frequencies of comorbidities by age category. Among DM-related comorbidities, peripheral vascular disease had the greatest impact on increasing the LOS or TC. Minimally invasive procedures, hemodialysis, ventilation, and procedure-related complications were significant determinants of TC. Hemodialysis and invasive surgical procedures were independent predictors of procedure-related complications. CONCLUSIONS DM-related comorbidities and care process representative of the DM case mix were responsible for variations in healthcare costs during hospitalization.
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Affiliation(s)
- Dulamsuren Lkhagva
- Department of Health Services Management and Policy, Graduate School of Medical Sciences, Kyushu University, Maidashi, Higashi-ku Fukuoka, Japan
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Wu CX, Tan WS, Toh MPHS, Heng BH. Stratifying healthcare costs using the Diabetes Complication Severity Index. J Diabetes Complications 2012; 26:107-12. [PMID: 22465400 DOI: 10.1016/j.jdiacomp.2012.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 02/21/2012] [Accepted: 02/21/2012] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- C X Wu
- Health Services and Outcomes Research, National Healthcare Group, Singapore 149547.
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Gregori D, Petrinco M, Bo S, Desideri A, Merletti F, Pagano E. Regression models for analyzing costs and their determinants in health care: an introductory review. Int J Qual Health Care 2011; 23:331-41. [PMID: 21504959 DOI: 10.1093/intqhc/mzr010] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This article aims to describe the various approaches in multivariable modelling of healthcare costs data and to synthesize the respective criticisms as proposed in the literature. METHODS We present regression methods suitable for the analysis of healthcare costs and then apply them to an experimental setting in cardiovascular treatment (COSTAMI study) and an observational setting in diabetes hospital care. RESULTS We show how methods can produce different results depending on the degree of matching between the underlying assumptions of each method and the specific characteristics of the healthcare problem. CONCLUSIONS The matching of healthcare cost models to the analytic objectives and characteristics of the data available to a study requires caution. The study results and interpretation can be heavily dependent on the choice of model with a real risk of spurious results and conclusions.
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Affiliation(s)
- Dario Gregori
- Department of Environmental Medicine and Public Health, Via Loredan 18, 35121 Padova, Italy.
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Riewpaiboon A, Chatterjee S, Riewpaiboon W, Piyauthakit P. Disability and cost for diabetic patients at a public district hospital in Thailand. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011; 19:84-93. [PMID: 21385239 DOI: 10.1111/j.2042-7174.2010.00078.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study determined the rate of disability among diabetic patients at a public district hospital in Thailand and compared the costs of illness among different levels of severity of disability. This was the first such study carried out in Thailand. METHODS The study was conducted at Waritchaphum Hospital in northeastern Thailand. Data were collected from 475 randomly selected diabetic patients identified by the World Health Organization's International Classification of Diseases, tenth revision (ICD-10 codes E10 - E14) who received treatment from the study hospital during the fiscal year of 2008. The disability levels were determined by using Thailand ministerial guidelines as well as the Barthel index score. Cost-of-illness estimates followed the prevalence-based approach and it presented the societal perspective of cost-of-illness of diabetes in 2008. KEY FINDINGS The study results showed that 9.68% of the study participants had physical impairment while 9.26% had impairment in eyesight. The Barthel index score showed that 13.5% of the study participants were disabled. When comparing costs between independent and disabled persons, considering the Barthel index score, average costs for the disabled diabetic persons were significantly higher than for those who were independent (US$2700.29 versus 598.24; P<0.001). CONCLUSIONS The study concluded that the presence of complications and disability among diabetic patients impacts severely on Thai society. At present, the Thai government allocates US$187.5 per annum to registered disabled persons as a disability living allowance. The study found a large difference between the direct economic outlay of the patients and the allowance provided, which suggests that there is probably a need to revise the welfare payment upwards.
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Affiliation(s)
- Arthorn Riewpaiboon
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok Center for Disease Dynamics, Economics and Policy, New Delhi, India
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Carpena MP, Rados DV, Sortica DA, Souza BMD, Reis AF, Canani LH, Crispim D. Genetics of diabetic nephropathy. ACTA ACUST UNITED AC 2010; 54:253-61. [PMID: 20520954 DOI: 10.1590/s0004-27302010000300002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 02/26/2010] [Indexed: 01/08/2023]
Abstract
The increasing prevalence of diabetes mellitus has led to a growing number of chronic complications including diabetic nephropathy (DN). In addition to its high prevalence, DN is associated with high morbidity and mortality especially due to cardiovascular diseases. It is well established that genetic factors play a role in the pathogenesis of DN and genetically susceptible individuals can develop it after being exposed to environmental factors. DN is probably a complex, polygenic disease. Two main strategies have been used to identify genes associated to DN: analysis of candidate genes, and more recently genome-wide scan. Great efforts have been made to identify these main genes, but results are still inconsistent with different genes associated to a small effect in specific populations. The identification of the main genes would allow the detection of those individuals at high risk for DN and better understanding of its pathophysiology as well.
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Abstract
AIMS We analysed the in-hospital costs of diabetic patients admitted to English hospitals and aimed to assess what proportions of cost variation are explained by patient and hospital characteristics. METHODS We used Hospital Episode Statistics and reference costs for all patients admitted to diabetes care for all English hospitals for the financial year 2005/2006. Our sample included 31 371 patients admitted to 148 hospitals. We applied a multi-level approach. We analysed the relationship between patient costs and patient characteristics. We estimated the average cost of being treated in each hospital after controlling for patient characteristics. In addition, we explored why these average costs vary across hospitals. RESULTS Much of the variation in the costs of controlling diabetes was driven by the Healthcare Resource Group to which the patient was allocated, but costs were also higher for patients who were transferred between hospitals, suffered infections and other complications, or for those who died in hospital. Even so, approximately 8-9% of the variation in costs was related to the hospital in which the patient was treated, with geographical variation in factor prices being the prime reason for this variation. The volume of patients, and the number and diversity of specialties involved in caring for diabetic patients did not explain the variation in the cost of treating diabetic patients across hospitals. CONCLUSIONS Healthcare Resource Groups and diagnostic markers are significant patient-related cost drivers in diabetes care. Costs are not lower in hospitals with a high volume of patients and where diabetes care is concentrated in few specialties.
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Affiliation(s)
- T Kristensen
- Department of Health Economics, Faculty of Social Sciences, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Lopez-de-Andres A, Carrasco-Garrido P, Esteban-Hernandez J, Gil-de-Miguel A, Jiménez-García R. Characteristics and hospitalization costs of patients with diabetes in Spain. Diabetes Res Clin Pract 2010; 89:e2-4. [PMID: 20435367 DOI: 10.1016/j.diabres.2010.03.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 03/29/2010] [Indexed: 11/25/2022]
Abstract
Using data from the Minimum Basic Dataset (MBDS) we described the hospitalizations in Spanish patients with diabetes. In 2007, acute diabetes-related complications accounted for 3.9% of admissions and chronic complications accounted for 30.3%. Mean cost per patient was euro4339. We conclude that diabetes had a high impact on hospitalizations including costs.
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Affiliation(s)
- Ana Lopez-de-Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda de Atenas s/n, Alcorcón, Madrid, Spain.
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Ritzwoller DP, Ellis JL, Korner EJ, Hartsfield CL, Sadosky A. Comorbidities, healthcare service utilization and costs for patients identified with painful DPN in a managed-care setting. Curr Med Res Opin 2009; 25:1319-28. [PMID: 19419344 DOI: 10.1185/03007990902864749] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study examined the association of comorbidities, healthcare service use, and costs for diabetes patients with and without painful diabetic peripheral neuropathy (pDPN). METHODS This was a retrospective, cohort analysis of data from members of a health maintenance organization. Patients with pDPN identified from a previously validated algorithm that was based on inclusion ICD-9 diagnosis codes consistent with signs and symptoms of peripheral neuropathy, as well as ICD-9 diagnosis codes to exclude non-diabetic etiologies. These subjects were matched 2 : 1 to patients without pDPN on age (+/-4 years), gender, and HbA(1c) stratum (<7%, 7-9%, and >9%) based on median HbA(1c) measured in 2002. Administrative data associated with outpatient and hospital-based care for the year 2003 were used to estimate healthcare service utilization and costs. Chi-square, univariate, and multivariate regression analyses were employed to estimate the variation in healthcare service utilization and costs. RESULTS After applying inclusion and exclusion criteria, 1543 patients with pPDN were matched to 3069 patients without pDPN among prevalent diabetes cases. Patients with pDPN had significantly higher prevalence of comorbidities, including twice as many limb infections and nearly ten-fold greater limb amputations, and had consistently higher healthcare service utilization and costs across categories of care. The likelihood of any hospital admission for pDPN patients was more than 2.5-fold higher relative to patients without pDPN, and the excess cost associated with pDPN was estimated to be almost $6000 for the calendar year. CONCLUSIONS The presence of pDPN in patients with diabetes was associated with significantly greater comorbidity, greater healthcare service utilization, and higher costs. While this study is limited to the direct medical care costs borne by the health plan, given the association of comorbidities and cost for patients with pDPN, further investigation is needed to determine if management approaches that are effective across chronic illnesses may prove to be beneficial for high cost diabetes patients.
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Affiliation(s)
- Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Institute for Health Research, Denver, CO 80237-8066, USA.
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Current literature in diabetes. Diabetes Metab Res Rev 2009; 25:i-xii. [PMID: 19405078 DOI: 10.1002/dmrr.973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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