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Yuan S, Wu Y. Effectiveness and cost-effectiveness of six GLP-1RAs for treatment of Chinese type 2 diabetes mellitus patients that inadequately controlled on metformin: a micro-simulation model. Front Public Health 2023; 11:1201818. [PMID: 37744474 PMCID: PMC10513082 DOI: 10.3389/fpubh.2023.1201818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To systematically estimate and compare the effectiveness and cost-effectiveness of the glucagon-like peptide-1 receptor agonists (GLP-1RAs) approved in China and to quantify the relationship between the burden of diabetic comorbidities and glycosylated hemoglobin (HbA1c) or body mass index (BMI). Methods To estimate the costs (US dollars, USD) and quality-adjusted life years (QALY) for six GLP-1RAs (exenatide, loxenatide, lixisenatide, dulaglutide, semaglutide, and liraglutide) combined with metformin in the treatment of patients with type 2 diabetes mellitus (T2DM) which is inadequately controlled on metformin from the Chinese healthcare system perspective, a discrete event microsimulation cost-effectiveness model based on the Chinese Hong Kong Integrated Modeling and Evaluation (CHIME) simulation model was developed. A cohort of 30,000 Chinese patients was established, and one-way sensitivity analysis and probabilistic sensitivity analysis (PSA) with 50,000 iterations were conducted considering parameter uncertainty. Scenario analysis was conducted considering the impacts of research time limits. A network meta-analysis was conducted to compare the effects of six GLP-1RAs on HbA1c, BMI, systolic blood pressure, and diastolic blood pressure. The incremental net monetary benefit (INMB) between therapies was used to evaluate the cost-effectiveness. China's per capita GDP in 2021 was used as the willingness-to-pay threshold. A generalized linear model was used to quantify the relationship between the burden of diabetic comorbidities and HbA1c or BMI. Results During a lifetime, the cost for a patient ranged from USD 42,092 with loxenatide to USD 47,026 with liraglutide, while the QALY gained ranged from 12.50 with dulaglutide to 12.65 with loxenatide. Compared to exenatide, the INMB of each drug from highest to lowest were: loxenatide (USD 1,124), dulaglutide (USD -1,418), lixisenatide (USD -1,713), semaglutide (USD -4,298), and liraglutide (USD -4,672). Loxenatide was better than the other GLP-1RAs in the base-case analysis. Sensitivity and scenario analysis results were consistent with the base-case analysis. Overall, the price of GLP-1RAs most affected the results. Medications with effective control of HbA1c or BMI were associated with a significantly smaller disease burden (p < 0.05). Conclusion Loxenatide combined with metformin was identified as the most economical choice, while the long-term health benefits of patients taking the six GLP-1RAs are approximate.
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Affiliation(s)
| | - Yingyu Wu
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
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2
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Sun J, Hu W, Ye S, Deng D, Chen M. The Description and Prediction of Incidence, Prevalence, Mortality, Disability-Adjusted Life Years Cases, and Corresponding Age-Standardized Rates for Global Diabetes. J Epidemiol Glob Health 2023; 13:566-576. [PMID: 37400673 PMCID: PMC10469163 DOI: 10.1007/s44197-023-00138-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/25/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE Diabetes is a life-long disease that poses a serious threat to safety and health. We aimed to assess the disease burden attributable to diabetes globally and by different subgroups, and to predict future disease burden using statistical models. METHODS This study was divided into three stages. Firstly, we evaluated the disease burden attributable to diabetes globally and by different subgroups in 2019. Second, we assessed the trends from 1990 to 2019. We estimated the annual percentage change of disease burden by applying a linear regression model. Finally, the age-period-cohort model was used to predict the disease burden from 2020 to 2044. Sensitivity analysis was performed with time-series models. RESULTS In 2019, the number of incidence cases of diabetes globally was 22239396 (95% uncertainty interval (UI): 20599519-24058945). The number of prevalence cases was 459875371 (95% UI 423474244-497980624) the number of deaths cases was 1551170 (95% UI 1445555-1650675) and the number of disability-adjusted life years cases was 70880155 (95% UI 59707574-84174005). The disease burden was lower in females than males and increased with age. The disease burden associated with type 2 diabetes mellitus was greater than that with type 1; the burden also varied across different socio-demographic index regions and different countries. The global disease burden of diabetes increased significantly over the past 30 years and will continue to increase in the future. CONCLUSION The disease burden of diabetes contributed significantly to the global disease burden. It is important to improve treatment and diagnosis to halt the growth in disease burden.
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Affiliation(s)
- Jianran Sun
- Department of Endocrinology, Division of Life Science and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001 Anhui China
| | - Wan Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032 Anhui China
| | - Shandong Ye
- Department of Endocrinology, Division of Life Science and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001 Anhui China
| | - Datong Deng
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
| | - Mingwei Chen
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022 Anhui China
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3
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Pan Q, Fei S, Zhang L, Chen H, Luo J, Wang W, Xiao F, Guo L. How does diabetic peripheral neuropathy impact patients' burden of illness and the economy? A retrospective study in Beijing, China. Front Public Health 2023; 11:1164536. [PMID: 37250086 PMCID: PMC10213523 DOI: 10.3389/fpubh.2023.1164536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Diabetic peripheral neuropathy (DPN) causes significant illness in patients and has a negative impact on the economy. The objective of this study is to evaluate the cost and quantity of anti-diabetic drugs needed by patients with or without DPN, as well as their variation trends in Beijing between 2016 and 2018. Methods This observational cross-sectional study used data on diabetic patients with outpatient medication records obtained from Beijing Medical Insurance from 2016 to 2018. The medications, comorbidities, diabetes-related complications, treatment strategies, and costs of drug treatment were compared between DPN patients and non-DPN patients. Results Of the 28,53,036 diabetic patients included in the study, 3,75,216 (13.15%) had DPN and 1,87,710 (50.03%) of the DPN patients were women. Compared with non-DPN patients, DPN patients used more mediations (4.7 ± 2.47 vs. 3.77 ± 2.32, p < 0.0001, in 2018) to treat related complications and comorbidities (2.03 ± 1.2 vs. 1.71 ± 1.05; 2.68 ± 1.93 vs. 2.06 ± 1.86, p < 0.0001, respectively, in 2018). The total annual costs of drug treatment were higher in DPN patients than in non-DPN patients (¥12583.25 ± 10671.48 vs. ¥9810.91 ± 9234.14, p < 0.0001, in 2018). The usage of DDP4i increased from 2.55 to 6.63% in non-DPN patients and from 4.45 to 10.09% in DPN patients from 2017 to 2018. Conclusions The number of comorbidities, diabetic complications, medications, and annual drug treatment costs were greater in DPN patients than in non-DPN patients.
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Affiliation(s)
- Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Sijia Fei
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Lina Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Huan Chen
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Jingyi Luo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Fei Xiao
- The Key Laboratory of Geriatrics, Beijing Institution of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Ossai CI, Wickramasinghe N. Sentiments prediction and thematic analysis for diabetes mobile apps using Embedded Deep Neural Networks and Latent Dirichlet Allocation. Artif Intell Med 2023; 138:102509. [PMID: 36990592 DOI: 10.1016/j.artmed.2023.102509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/21/2022] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
The increasing reliance on mobile health for managing disease conditions has opened a new frontier in digital health, thus, the need for understanding what constitutes positive and negative sentiments of the various apps. This paper relies on Embedded Deep Neural Networks (E-DNN), Kmeans, and Latent Dirichlet Allocation (LDA) for predicting the sentiments of diabetes mobile apps users and identifying the themes and sub-themes of positive and negative sentimental users. A total of 38,640 comments from 39 diabetes mobile apps obtained from the google play store are analyzed and accuracy of 87.67 % ± 2.57 % was obtained from a 10-fold leave-one-out cross-validation. This accuracy is 2.95 % - 18.71 % better than other predominant algorithms used for sentiment analysis and 3.47 % - 20.17 % better than the results obtained by previous researchers. The study also identified the challenges of diabetes mobile apps usage to include safety and security issues, outdated information for diabetes management, clumsy user interface, and difficulty controlling operations. The positives of the apps are ease of operation, lifestyle management, effectiveness in communication and control, and data management capabilities.
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Rosa LDS, Mistro S, Oliveira MG, Kochergin CN, Cortes ML, de Medeiros DS, Soares DA, Louzado JA, Silva KO, Bezerra VM, Amorim WW, Barone M, Passos LC. Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting. Front Pharmacol 2021; 11:588309. [PMID: 33542687 PMCID: PMC7851089 DOI: 10.3389/fphar.2020.588309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
Objective: We evaluated the cost-effectiveness of the point-of-care A1c (POC-A1c) test device vs. the traditional laboratory dosage in a primary care setting for people living with type 2 diabetes. Materials and Methods: The Markov model with a 10-year time horizon was based on data from the HealthRise project, in which a group of interventions was implemented to improve diabetes and hypertension control in the primary care network of the urban area of a Brazilian municipality. A POC-A1c device was provided to be used directly in a primary care unit, and for a period of 18 months, 288 patients were included in the point-of-care group, and 1,102 were included in the comparison group. Sensitivity analysis was performed via Monte Carlo simulation and tornado diagram. Results: The results indicated that the POC-A1c device used in the primary care unit was a cost-effective alternative, which improved access to A1c tests and resulted in an increased rate of early control of blood glucose. In the 10-year period, POC-A1c group presented a mean cost of US$10,503.48 per patient and an effectiveness of 0.35 vs. US$9,992.35 and 0.09 for the traditional laboratory test, respectively. The incremental cost was US$511.13 and the incremental effectiveness was 0.26, resulting in an incremental cost-effectiveness ratio of 1,947.10. In Monte Carlo simulation, costs and effectiveness ranged between $9,663.20-$10,683.53 and 0.33-0.37 for POC-A1c test group, and $9,288.28-$10,413.99 and 0.08-0.10 for traditional laboratory test group, at 2.5 and 97.5 percentiles. The costs for nephropathy, retinopathy, and cardiovascular disease and the probability of being hospitalized due to diabetes presented the greatest impact on the model's result. Conclusion: This study showed that using POC-A1c devices in primary care settings is a cost-effective alternative for monitoring glycated hemoglobin A1c as a marker of blood glucose control in people living with type 2 diabetes. According to our model, the use of POC-A1c device in a healthcare unit increased the early control of type 2 diabetes and, consequently, reduced the costs of diabetes-related outcomes, in comparison with a centralized laboratory test.
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Affiliation(s)
- Lorena de Sousa Rosa
- Program of Post-Graduation in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | - Sóstenes Mistro
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Marcio Galvão Oliveira
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | | | - Mateus Lopes Cortes
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Danielle Souto de Medeiros
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Daniela Arruda Soares
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - José Andrade Louzado
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Kelle Oliveira Silva
- Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Vanessa Moraes Bezerra
- Program of Post-Graduation in Collective Health, Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | - Welma Wildes Amorim
- Departament of Natural Sciences, State University of Southwest Bahia, Vitória da Conquista, Brazil
| | - Mark Barone
- Intersectoral Forum to Fight NCDs in Brazil, São Paulo, Brazil
| | - Luiz Carlos Passos
- Program of Post-Graduation in Medicine and Health, Federal University of Bahia, Salvador, Brazil
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6
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Wu T, Yang F, Chan WWL, Lam CLK, Wong CKH. Healthcare utilization and direct medical cost in the years during and after cancer diagnosis in patients with type 2 diabetes mellitus. J Diabetes Investig 2020; 11:1661-1672. [PMID: 32471010 PMCID: PMC7610124 DOI: 10.1111/jdi.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS/INTRODUCTION There is uncertainty about the direct medical costs of type 2 diabetes patients with cancers. MATERIALS AND METHODS A population-based retrospective cohort of 99,915 type 2 diabetes patients from the Hong Kong Hospital Authority between 2006 and 2017 was assembled. A total of 16,869 patients who had an initial cancer diagnosis after type 2 diabetes diagnosis were matched with 83,046 patients without cancer (controls) using a matching ratio of up to one-to-five propensity score-matching method. Patients were divided into four categories according to life expectancy. Healthcare service utilization and direct medical costs during the index year, subsequent years and mortality year were compared between patients with and without cancer in each category. RESULTS Medical costs of cancer patients in the index year ranged from $US27,533 for patients who died in <1 year to $US11,303 for those survived >3 years. Cancer patients had significantly greater expenditures than controls in the index year (all P < 0.001) and subsequent years ($US4,569 vs $US4,155, P < 0.001). Cancer patients also had greater costs in the year of death, and the difference was significant for patients who survived >3 years after the index year ($US32,558 vs $US28,260). For patients in both groups, patients who survived >3 years had significantly lower costs than those who died in <1 year. Costs incurred in the mortality year were greater than those in the index year and subsequent years. Hospitalization accounted for >90% of the medical costs for both groups in the mortality year. CONCLUSIONS Type 2 diabetes patients with cancers incurred greater medical costs in the diagnosis, ensuing and mortality years than type 2 diabetes patients without cancers.
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Affiliation(s)
- Tingting Wu
- Department of Family Medicine and Primary CareThe University of Hong KongHong Kong
| | - Fan Yang
- Centre for Health EconomicsThe University of YorkYorkUK
| | | | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary CareThe University of Hong KongHong Kong
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary CareThe University of Hong KongHong Kong
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Chen HY, Kuo S, Su PF, Wu JS, Ou HT. Health Care Costs Associated With Macrovascular, Microvascular, and Metabolic Complications of Type 2 Diabetes Across Time: Estimates From a Population-Based Cohort of More Than 0.8 Million Individuals With Up to 15 Years of Follow-up. Diabetes Care 2020; 43:1732-1740. [PMID: 32444454 PMCID: PMC7372047 DOI: 10.2337/dc20-0072] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Developing country-specific unit-cost catalogs is a key area for advancing economic research to improve medical and policy decisions. However, little is known about how health care costs vary by type 2 diabetes (T2D) complications across time in Asian countries. We sought to quantify the economic burden of various T2D complications in Taiwan. RESEARCH DESIGN AND METHODS A nationwide, population-based, longitudinal study was conducted to analyze 802,429 adults with newly diagnosed T2D identified during 1999-2010 and followed up until death or 31 December 2013. Annual health care costs associated with T2D complications were estimated, with multivariable generalized estimating equation models adjusted for individual characteristics. RESULTS The mean annual health care cost was $281 and $298 (2017 U.S. dollars) for a male and female, respectively, diagnosed with T2D at age <50 years, with diabetes duration of <5 years, and without comorbidities, antidiabetic treatments, and complications. Depression was the costliest comorbidity, increasing costs by 64-82%. Antidiabetic treatments increased costs by 72-126%. For nonfatal complications, costs increased from 36% (retinopathy) to 202% (stroke) in the event year and from 13% (retinopathy or neuropathy) to 49% (heart failure) in subsequent years. Costs for the five leading costly nonfatal subtype complications increased by 201-599% (end-stage renal disease with dialysis), 37-376% (hemorrhagic/ischemic stroke), and 13-279% (upper-/lower-extremity amputation). For fatal complications, costs increased by 1,784-2,001% and 1,285-1,584% for cardiovascular and other-cause deaths, respectively. CONCLUSIONS The cost estimates from this study are crucial for parameterizing diabetes economic simulation models to quantify the economic impact of clinical outcomes and determine cost-effective interventions.
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Affiliation(s)
- Hsuan-Ying Chen
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shihchen Kuo
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Pei-Fang Su
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Division of Family Medicine, National Cheng Kung University Hospital, Dou-Liu Branch, Douliu, Taiwan
| | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan
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Alzaid A, Ladrón de Guevara P, Beillat M, Lehner Martin V, Atanasov P. Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses. Expert Rev Pharmacoecon Outcomes Res 2020; 21:785-798. [PMID: 32686530 DOI: 10.1080/14737167.2020.1782748] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: To estimate the clinical and economic burden of type 2 diabetes (T2D) in established (EST) and emerging markets (EMG).Methods: Three systematic literature reviews were conducted in MEDLINE and Embase to capture all relevant publications reporting 1) the epidemiology of T2D and complications in T2D and 2) the economic burden of T2D and associated complications.Results: In total, 294 studies were included in this analysis. Evidence indicates a high and increasing overall prevalence of T2D globally, ranging up to 23% in EMG markets and 14% in EST markets. Undiagnosed cases were higher in EMG versus EST markets (up to 67% vs 38%), potentially due to a lack of education and disease awareness in certain regions, that could lead to important clinical and economic consequences. Poor glycemic control was associated with the development of several complications (e.g. retinopathy, cardiovascular diseases and nephropathy) that increase the risk of morbidity and mortality. Direct costs were up to 9-fold higher in patients with vs without T2D-related complications.Conclusions: The burden of T2D, related complications and inherent costs are higher in emerging versus established market countries. This review explores potential strategies to reduce costs and enhance outcomes of T2D treatment in developing countries.
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Affiliation(s)
- Aus Alzaid
- Consultant Diabetologist, Riyadh, Saudi Arabia
| | - Patricia Ladrón de Guevara
- Health Economics & Market Access, Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | - Maud Beillat
- Global Market Access, Health Economics & Outcomes Research, Servier Global Market Access & HEOR, France
| | | | - Petar Atanasov
- Health Economics & Market Access, Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
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9
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Wu Y, Zhou Y, Wang X, Zhang Q, Yao X, Li X, Li J, Tian H, Li S. A Comparison of Functional Features in Chinese and US Mobile Apps for Diabetes Self-Management: A Systematic Search in App Stores and Content Analysis. JMIR Mhealth Uhealth 2019; 7:e13971. [PMID: 31464191 PMCID: PMC6737884 DOI: 10.2196/13971] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/04/2019] [Accepted: 07/07/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mobile health interventions are widely used for self-management of diabetes, which is one of the most burdensome noncommunicable chronic diseases worldwide. However, little is known about the distribution of characteristics and functions of in-store mobile apps for diabetes. OBJECTIVE This study aimed to investigate the distribution of characteristics and functions of the in-store mobile apps for self-management of diabetes in the United States and China using a predefined functional taxonomy, which was developed and published in our previous study. METHODS We identified apps by searching diabetes in English or Chinese in the Apple iTunes Store and Android Markets (both in the United States and China) and included apps for diabetes self-management. We examined the validity and reliability of the predefined functional taxonomy with 3 dimensions: clinical module, functional module, and potential risk. We then classified all functions in the included apps according to the predefined taxonomy and compared the differences in the features of these apps between the United States and China. RESULTS We included 171 mobile diabetes apps, with 133 from the United States and 38 from China. Apps from both countries faced the challenges of evidence-based information, proper risk assessment, and declaration, especially Chinese apps. More Chinese apps provide app-based communication functions (general communication: Chinese vs US apps, 39%, 15/38 vs 18.0%, 24/133; P=.006 and patient-clinician communication: Chinese vs US apps, 68%, 26/38 vs 6.0%, 8/133; P<.001), whereas more US apps provide the decision-making module (Chinese vs US apps, 0%, 0/38 vs 23.3%, 31/133; P=.001), which is a high-risk module. Both complication prevention (Chinese vs US apps, 8%, 3/38 vs 3.8%, 5/133; P=.50) and psychological care (Chinese vs US apps, 0%, 0/38 vs 0.8%, 1/133; P>.99) are neglected by the 2 countries. CONCLUSIONS The distribution of characteristics and functions of in-store mobile apps for diabetes self-management in the United States was different from China. The design of in-store diabetes apps needs to be monitored closely.
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Affiliation(s)
- Yuan Wu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.,Xi An Jiao Tong University, The First Affiliated Hospital of Xi An Jiao Tong University, Xi An, China
| | - Yiling Zhou
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.,Department of Population Health & Genomics, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Xuan Wang
- Department of Population Health & Genomics, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.,Science for Life Laboratory, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Qi Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xun Yao
- Department of Academic Affairs, West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiaodan Li
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China.,Medicines Monitoring Unit, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Jianshu Li
- Department of Biomedical Polymer and Artificial Organs, College of Polymer Science and Engineering, Sichuan University, Chengdu, China
| | - Haoming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.,Department of Population Health & Genomics, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
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10
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Wong CKH, Tong T, Cheng GHL, Tang EHM, Thokala P, Tse ETY, Lam CLK. Direct medical costs in the preceding, event and subsequent years of a first severe hypoglycaemia episode requiring hospitalization: A population-based cohort study. Diabetes Obes Metab 2019; 21:1330-1339. [PMID: 30737873 DOI: 10.1111/dom.13657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 01/02/2023]
Abstract
AIMS We aimed to estimate the use of healthcare services and the direct medical costs accrued by patients with diabetes mellitus (DM) during the year of the first severe hypoglycaemia (SH) event, as well as during the years before and after the event year. MATERIALS AND METHODS We analysed a population-based, retrospective cohort including all adults with DM managed in the primary care setting from the Hong Kong Hospital Authority between 2006 and 2013. DM patients for whom SH was first recorded during the designated period were identified and matched to a control group of patients who had not experienced an SH event using the propensity score method. Direct medical costs in the years before, during and after the first SH event were determined by totalling the costs of health services utilized within respective years. RESULTS After matching, a total of 22 694 DM patients were divided into the first recorded-SH group (n = 11 347) and the non-SH control group (n = 11 347). Patients for whom SH was first recorded, on average, made 7.85 outpatient clinic visits, made 1.89 emergency visits and spent 17.75 nights hospitalized during the event year. Mean direct medical costs during the event year were 11 751 US$, more than 2-fold that during the preceding year (4846 US$; P < 0.001) and subsequent years (4198-4700 US$; P < 0.001) and was 4.5 times that 2 years before the event (2481 US$; P < 0.001). Incremental costs of SH patients vs matched controls during the event year and the preceding year were 10 873 US$ (P < 0.001) and 3974 US$ (P < 0.001), respectively. CONCLUSIONS SH is associated with excessive hospital admission rates and direct medical costs during the event year and, in particular, during the year before as compared to patients who had not experienced an SH event.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Thaison Tong
- Health Economics and Decision Science, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Garvin H L Cheng
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Eric H M Tang
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Praveen Thokala
- Health Economics and Decision Science, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Emily T Y Tse
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
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