1
|
Rawat S, Bansal N, Yadav R, Goyal S, Nagpal J. Out-of-pocket direct cost of ambulatory care of type 2 diabetes in Delhi: Estimates from the Delhi diabetes community-II (DEDICOM-II) survey. Diabetes Metab Syndr 2024; 18:103089. [PMID: 39126763 DOI: 10.1016/j.dsx.2024.103089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 07/15/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND & AIM Much of the cost data from India is restricted to patients recruited purely from healthcare institutions and do not explore determinants. Therefore, the out of pocket expenditure for ambulatory diabetes care was evaluated in Delhi. METHODS The DEDICOM-II survey used a two-stage probability-proportionate-to-size(systematic) cluster design. Thirty clusters were chosen to recruit 25 to 30 subjects per area. We used questionnaires to estimate the direct out-of-pocket expenditure (OOPE) on drugs, investigations, consultation and travel, excluding hospitalization, and then analysed its determinants and impact on quality of care. RESULTS We enrolled 843 subjects with a mean age of 53.1 years. The annual direct OOPE on ambulatory care of diabetes was US$ 116.3 (95 % CI 93.8-138.9) or INR 8074.8 (95 % CI 6512.9-9636.7), corresponding to 3.6 %(95 % CI 2.9-4.3) of the yearly family income. The burden of expenses was disproportionately higher for those visiting private providers from lower-income groups(19.1 %). Duration of disease and treatment with insulin predicted higher annual OOPE while care at public facilities was less expensive. Cost was higher for those adhering to the recommended processes of care. Quality of care was better for institutional care and worse for alternative medicine or self-care. CONCLUSIONS The study provides representative estimates of the high cost of diabetes management in Delhi across the socio-economic and care provider spectra. Poorer patients suffer a high financial burden from diabetes, highlighting the need for enhancing equity in diabetes care.
Collapse
Affiliation(s)
- Swapnil Rawat
- Sitaram Bhartia Institute of Science and Research, B-16 Qutub Institutional Area, New Delhi, 110016, India
| | - Neetu Bansal
- Sitaram Bhartia Institute of Science and Research, B-16 Qutub Institutional Area, New Delhi, 110016, India
| | - Ramasheesh Yadav
- Sitaram Bhartia Institute of Science and Research, B-16 Qutub Institutional Area, New Delhi, 110016, India
| | - Siddhi Goyal
- Sitaram Bhartia Institute of Science and Research, B-16 Qutub Institutional Area, New Delhi, 110016, India
| | - Jitender Nagpal
- Sitaram Bhartia Institute of Science and Research, B-16 Qutub Institutional Area, New Delhi, 110016, India.
| |
Collapse
|
2
|
Lum ZK, Tan JY, Wong CSM, Kok ZY, Kwek SC, Tsou KYK, Gallagher PJ, Lee JYC. Reducing economic burden through split-shared care model for people living with uncontrolled type 2 diabetes and polypharmacy: a multi-center randomized controlled trial. BMC Health Serv Res 2024; 24:760. [PMID: 38907254 PMCID: PMC11193226 DOI: 10.1186/s12913-024-11199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Interprofessional collaborative care such as a split-shared care model involving family physicians and community pharmacists can reduce the economic burden of diabetes management. This study aimed to evaluate the economic outcome of a split-shared care model between family physicians and community pharmacists within a pharmacy chain in managing people with uncontrolled type 2 diabetes and polypharmacy. METHOD This was a multi-center, parallel arm, open label, randomized controlled trial comparing the direct and indirect economic outcomes of people who received collaborative care involving community pharmacists (intervention) versus those who received usual care without community pharmacist involvement (control). People with uncontrolled type 2 diabetes, defined as HbA1c > 7.0% and taking ≥ 5 chronic medications were included while people with missing baseline economic data (such as consultation costs, medication costs) were excluded. Direct medical costs were extracted from the institution's financial database while indirect costs were calculated from self-reported gross income and productivity loss, using Work Productivity Activity Impairment Global Health questionnaire. Separate generalized linear models with log link function and gamma distribution were used to analyze changes in direct and indirect medical costs. RESULTS A total of 175 patients (intervention = 70, control = 105) completed the trial and were included for analysis. The mean age of the participants was 66.9 (9.2) years, with majority being male and Chinese. The direct medical costs were significantly lower in the intervention than the control group over 6 months (intervention: -US$70.51, control: -US$47.66, p < 0.001). Medication cost was the main driver in both groups. There were no significant changes in productivity loss and indirect costs in both groups. CONCLUSION Implementation of split-shared visits with frontline community partners may reduce economic burden for patient with uncontrolled type 2 diabetes and polypharmacy. TRIAL REGISTRATION Clinicaltrials.gov Reference Number: NCT03531944 (Date of registration: June 6, 2018).
Collapse
Affiliation(s)
- Zheng Kang Lum
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, MD1, Tahir Foundation Building, National University of Singapore, 12 Science Drive #06-03, Singapore, 117549, Singapore
| | - Jia Yeong Tan
- Keat Hong Family Medicine Clinic, Trilink Healthcare Private Limited, 2 Choa Chu Kang Loop, Singapore, #03-02, Singapore
| | - Cynthia Sze Mun Wong
- Bukit Batok Polyclinic, National University Polyclinics, 50 Bukit Batok West Ave 3, Singapore, 659164, Singapore
| | - Zi Yin Kok
- Keat Hong Family Medicine Clinic, Trilink Healthcare Private Limited, 2 Choa Chu Kang Loop, Singapore, #03-02, Singapore
| | - Sing Cheer Kwek
- Bukit Batok Polyclinic, National University Polyclinics, 50 Bukit Batok West Ave 3, Singapore, 659164, Singapore
| | - Keith Yu Kei Tsou
- Bukit Batok Polyclinic, National University Polyclinics, 50 Bukit Batok West Ave 3, Singapore, 659164, Singapore
| | - Paul John Gallagher
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, MD1, Tahir Foundation Building, National University of Singapore, 12 Science Drive #06-03, Singapore, 117549, Singapore.
| | - Joyce Yu-Chia Lee
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California, 101 Theory, Suite 100, Irvine, CA, 92697, USA.
| |
Collapse
|
3
|
Bonča PD, Gavrić D, Janša K, Sambt J. Direct diabetes-related healthcare expenditures in Slovenia: recent evolution and future projections based on population-level data. Expert Rev Pharmacoecon Outcomes Res 2024; 24:427-436. [PMID: 38189093 DOI: 10.1080/14737167.2024.2302423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The burden of diabetes on individuals, healthcare systems, and society must be explored to improve and sustain diabetes care. With this aim, we estimated both past and future diabetes-related direct health expenditures in Slovenia. METHODS Analysis of expenditures from the healthcare payer perspective during the 2019-2022 period was based on individual patient data on expenditures for seven groups of diabetes-related medical conditions from the population-level database of the Health Insurance Institute of Slovenia. Expenditure projections were prepared using the European Commission's methodology for budgetary projections. RESULTS In the 2019-2022 period, average annual diabetes-related expenditures equaled €174.1 million (€1,108 per patient), with their average annual growth rate reaching 12.5%. Expenditures due to inpatient care (33%) and drugs used in diabetes (24%) had the highest shares. More than half of the expenditures were due to complications of diabetes. The diabetes-related expenditures as a share of GDP are projected to increase by 19.2% from 2019 to 2030, with slower yet continued growth up to 2050. CONCLUSIONS Diabetes-related expenditures in Slovenia continue to rise. By focusing on the prevention and optimal management of diabetes, its impact on the healthcare system could be reduced significantly, given the magnitude of expenditures attributed to complications.
Collapse
Affiliation(s)
- Petra Došenović Bonča
- Academic Unit for Economics, School of Economics and Business, University of Ljubljana, Ljubljana, Slovenia
| | - Dalibor Gavrić
- Department for Development and Analysis, The Health Insurance Institute of Slovenia, Ljubljana, Slovenia
| | - Karmen Janša
- Department for Development and Analysis, The Health Insurance Institute of Slovenia, Ljubljana, Slovenia and Department of Internal Medicine, General Hospital Jesenice, Jesenice, Slovenia
| | - Jože Sambt
- Academic Unit for Mathematics, Statistics and Operations Research, School of Economics and Business, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
4
|
Salama RAM, Raafat FA, Hasanin AH, Hendawy N, Saleh LA, Habib EK, Hamza M, Hassan ANE. A neuroprotective effect of pentoxifylline in rats with diabetic neuropathy: Mitigation of inflammatory and vascular alterations. Int Immunopharmacol 2024; 128:111533. [PMID: 38271813 DOI: 10.1016/j.intimp.2024.111533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Treatment of diabetic neuropathic pain does not change the natural history of neuropathy. Improved glycemic control is the recommended treatment in these cases, given that no specific treatment for the underlying nerve damage is available, so far. In the present study, the potential neuroprotective effect of pentoxifylline in streptozotocin (50 mg/kg) induced diabetic neuropathy in rats was investigated. METHODS Pentoxifylline was administered at doses equivalent to 50, 100 & 200 mg/kg, in drinking water, starting one week after streptozotocin injection and for 7 weeks. Mechanical allodynia, body weight and blood glucose level were assessed weekly. Epidermal thickness of the footpad skin, and neuroinflammation and vascular alterations markers were assessed. RESULTS Tactile allodynia was less in rats that received pentoxifylline at doses of 100 and 200 mg/kg (60 % mechanical threshold increased by 48 % and 60 %, respectively). The decrease in epidermal thickness of footpad skin was almost completely prevented by the same doses. This was associated with a decrease in spinal tumor necrosis factor alpha (TNFα) and nuclear factor kappa B levels and a decrease in microglial ionized calcium binding adaptor molecule 1 immunoreactivity, compared to the control diabetic group. In sciatic nerve, there was decrease in TNF-α and vascular endothelial growth factor levels and intercellular adhesion molecule immunoreactivity. CONCLUSION Pentoxifylline showed a neuroprotective effect in streptozotocin-induced diabetic neuropathy, which was associated with a suppression of both the inflammatory and vascular pathogenic pathways that was not associated with a hypoglycemic effect. Thus, it may represent a potential neuroprotective drug for diabetics.
Collapse
Affiliation(s)
- Raghda A M Salama
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Fatema Ahmed Raafat
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amany Helmy Hasanin
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nevien Hendawy
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Faculty of Medicine, Galala University, Suez, Egypt
| | - Lobna A Saleh
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman K Habib
- Faculty of Medicine, Galala University, Suez, Egypt; Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - May Hamza
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Ahmed Nour Eldin Hassan
- Department of Clinical Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Faculty of Medicine, Galala University, Suez, Egypt
| |
Collapse
|
5
|
Heinemann L. Automated Insulin Delivery System and People With Type 2 Diabetes: A Topic With Many Facets. J Diabetes Sci Technol 2023:19322968231204625. [PMID: 37807907 DOI: 10.1177/19322968231204625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Optimizing glucose control is of interest also for patients with type 2 diabetes (T2D). While systems for automated insulin delivery are widely used for patients with type 1 diabetes, as documented by many publications, this is not the case with T2D. Because of the number of such patients, this will change drastically in the next years. Manufacturers can transfer many learnings from type 1 to type 2; however, specific clinical aspects have to be considered. This commentary will discuss these aspects and some of the current activities. Future automated insulin delivery (AID) systems will take data from multisensor systems into account to individualize the AID algorithm, supported by artificial intelligence. There is a high need to document the benefits of AID systems in this patient group.
Collapse
Affiliation(s)
- Lutz Heinemann
- Science Consulting in Diabetes GmbH, Düsseldorf, Germany
| |
Collapse
|
6
|
Mahamud B, Suthar RK, Mohamed A, Hamid K, Mlawa G. Effectiveness of Bariatric Surgery in the Management of Type 2 Diabetes Mellitus: A Case Report and Literature Review. Cureus 2023; 15:e47843. [PMID: 38021602 PMCID: PMC10677717 DOI: 10.7759/cureus.47843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Type 2 diabetes (T2DM) and obesity represent major global health burdens and economic costs to healthcare systems. T2DM management is challenging due to multiple comorbidities and limited drug efficacy. Bariatric surgery has emerged as an effective treatment approach. A 65-year-old man with refractory obesity (BMI > 35 kg/m2) and poorly controlled T2DM underwent gastric bypass surgery in 2018. Prior to surgery, medication noncompliance and dietary measures failed to achieve adequate glycemic control or weight loss. Postoperatively, the patient lost 20 kg and achieved improved T2DM control (HbA1C reduction), allowing complete cessation of diabetic medications. The patient's case demonstrates bariatric surgery's potential to significantly alter the clinical course of obesity and T2DM versus standard care. National guidelines outline eligibility criteria for bariatric referral; however, utilization rates remain low (<1%) despite over two million eligible individuals in the United Kingdom. Improved access could reduce disease burden and healthcare costs from diabetes complications over the long term. This case report provides a real-world example supporting bariatric surgery as an effective intervention for appropriately selected patients with obesity and uncontrolled T2DM, with the potential to improve clinical outcomes and lower costs associated with diabetes management.
Collapse
Affiliation(s)
- Bashir Mahamud
- Medicine, Trakia Medical University, Stara Zagora, BGR
- Acute Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Rohan K Suthar
- Respiratory Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Ayan Mohamed
- Internal Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Kedir Hamid
- Internal Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| | - Gideon Mlawa
- Internal Medicine and Diabetes and Endocrinology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
| |
Collapse
|
7
|
Seidel F, Oebel B, Stein L, Michalke A, Gaugler T. The True Price of External Health Effects from Food Consumption. Nutrients 2023; 15:3386. [PMID: 37571323 PMCID: PMC10421383 DOI: 10.3390/nu15153386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/16/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Although global food consumption costs more in terms of impact on human life than money is spent on it, health costs have not been consistently quantified or included in food prices to date. In this paper, a method to determine the external health costs of nutrition and dietetics is developed by employing the cost-of-illness (COI) and true cost accounting (TCA) approaches. This is done exemplarily for the reference country Germany. The results show that 601.50 € per capita and 50.38 billion € in total external health costs are incurred annually due to nutrition. Overall, most costs are accrued through excessive meat consumption (32.56% of costs), deficient whole grain intake (15.42% of costs), and insufficient uptake of legumes (10.19% of costs). Comparing the external health costs with the external environmental costs in Germany, it can be seen that of the total annual costs of around 153.86 billion €, 67.26% originate from environmental impacts and 32.74% from impacts on human life. In order to achieve the 17 Sustainable Development Goals and to increase family as well as public health, there is a need to internalise these external costs into actual food prices.
Collapse
Affiliation(s)
- Felix Seidel
- Faculty of Mathematics, Natural Sciences, and Materials Engineering, University of Augsburg, 86159 Augsburg, Germany;
| | - Benjamin Oebel
- Faculty of Business Administration, Nuremberg Institute of Technology, 90489 Nuremberg, Germany;
| | - Lennart Stein
- Faculty of Mathematics and Natural Sciences, University of Greifswald, 17489 Greifswald, Germany; (L.S.); (A.M.)
| | - Amelie Michalke
- Faculty of Mathematics and Natural Sciences, University of Greifswald, 17489 Greifswald, Germany; (L.S.); (A.M.)
| | - Tobias Gaugler
- Faculty of Business Administration, Nuremberg Institute of Technology, 90489 Nuremberg, Germany;
| |
Collapse
|
8
|
Karimah RN, Kusnanto H, Lazuardi L. Development of the information quality scale for health information supply chain type 2 diabetes mellitus management using exploratory factor analysis. J Public Health Res 2023; 12:22799036231170843. [PMID: 37188060 PMCID: PMC10176562 DOI: 10.1177/22799036231170843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/01/2023] [Indexed: 05/17/2023] Open
Abstract
Background Research on the quality scale of the healthcare supply chain is still limited. This study aimed to assess the information quality of the supply chain model with a focus on construct validity. Studies related to information quality measurement generally focus on measuring the dimensions of the completeness of medical records and consumer perspectives. We intended to assess the scale based on doctors needed as care coordinators on type 2 diabetes mellitus or the Non-Insulin-Dependent-Diabetes-Mellitus (NIDDM) program in primary healthcare. Methods Sixty-four primary healthcare doctors with an age range of 24-51 years were involved in this research. The scale obtained was formed from the assessment of the point of view of a panel of experts through the content validity index (CVI). The exploratory factor analysis (EFA) method was used to explore the scale of information quality in the information supply chain model for the NIDDM chronic disease management program. Result The data analysis results indicated three main factors that affected the quality of the information supply chain model of NIDDM, namely accessibility, safety, and efficiency of information related to NIDDM. The results of the validity and reliability of the data showed that the scale used in this research was valid and reliable with a Cronbach alpha coefficient of 0.861. Conclusion The scale developed in this research could be used to explore the quality of the information supply chain of NIDDM management in primary healthcare. Each item on the scale could explain the variables according to their respective groups.
Collapse
Affiliation(s)
- Rinda Nurul Karimah
- Doctoral Program of Medicine and
Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada,
Yogyakarta, Indonesia
- Department of Health Science,
Politeknik Negeri Jember, East Java, Indonesia
| | - Hari Kusnanto
- Department of Family and Community
Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada,
Yogyakarta, Indonesia
| | - Lutfan Lazuardi
- Department of Health Policy and
Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada,
Yogyakarta, Indonesia
- Lutfan Lazuardi, Department of Health
Policy and Management, Faculty of medicine, Public Health and Nursing,
Universitas Gadjah Mada, Yogyakarta 55281, Indonesia.
| |
Collapse
|
9
|
Danhieux K, Buffel V, Remmen R, Wouters E, van Olmen J. Scale-up of a chronic care model-based programme for type 2 diabetes in Belgium: a mixed-methods study. BMC Health Serv Res 2023; 23:141. [PMID: 36759890 PMCID: PMC9911183 DOI: 10.1186/s12913-023-09115-1] [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: 09/13/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is an increasingly dominant disease. Interventions are more effective when carried out by a prepared and proactive team within an organised system - the integrated care (IC) model. The Chronic Care Model (CCM) provides guidance for its implementation, but scale-up of IC is challenging, and this hampers outcomes for T2D care. In this paper, we used the CCM to investigate the current implementation of IC in primary care in Flanders (Belgium) and its variability in different practice types. METHODS Belgium contains three different primary-care practice types: monodisciplinary fee-for-service practices, multidisciplinary fee-for-service practices and multidisciplinary capitation-based practices. Disproportional sampling was used to select a maximum of 10 practices for each type in three Flemish regions, leading to a total of 66 practices. The study employed a mixed methods design whereby the Assessment of Chronic Illness Care (ACIC) was complemented with interviews with general practitioners, nurses and dieticians linked to the 66 practices. RESULTS The ACIC scores of the fee-for-service practices - containing 97% of Belgian patients - only corresponded to basic support for chronic illness care for T2D. Multidisciplinary and capitation-based practices scored considerably higher than traditional monodisciplinary fee-for-service practices. The region had no significant impact on the ACIC scores. Having a nurse, being a capitation practice and having a secretary had a significant effect in the regression analysis, which explained 75% of the variance in ACIC scores. Better-performing practices were successful due to clear role-defining, task delegation to the nurse, coordination, structured use of the electronic medical record, planning of consultations and integration of self-management support, and behaviour-change intervention (internally or using community initiatives). The longer nurses work in primary care practices, the higher the chance that they perform more advanced tasks. CONCLUSIONS Besides the presence of a nurse or secretary, also working multidisciplinary under one roof and a capitation-based financing system are important features of a system wherein IC for T2D can be scaled-up successfully. Belgian policymakers should rethink the role of paramedics in primary care and make the financing system more integrated. As the scale-up of the IC varied highly in different contexts, uniform roll-out across a health system containing multiple types of practices may not be successful.
Collapse
Affiliation(s)
- Katrien Danhieux
- Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium. .,Institute of Tropical Medicine Antwerp, Antwerp, Belgium.
| | - Veerle Buffel
- grid.5284.b0000 0001 0790 3681Center for Population, Family and Health, University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- grid.5284.b0000 0001 0790 3681Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- grid.5284.b0000 0001 0790 3681Center for Population, Family and Health, University of Antwerp, Antwerp, Belgium
| | - Josefien van Olmen
- grid.5284.b0000 0001 0790 3681Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium ,grid.11505.300000 0001 2153 5088Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| |
Collapse
|
10
|
Pelosi E. Effect of oral enzyme combination, diet and exercise on chronic low-grade inflammatory conditions-a report of three cases. AME Case Rep 2023; 7:7. [PMID: 36817707 PMCID: PMC9929666 DOI: 10.21037/acr-22-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/17/2022] [Indexed: 01/08/2023]
Abstract
Background Chronic low-grade inflammation is a common feature of different diseases such as type 2 diabetes, osteoarthrosis and psoriasis. Patients with asthenia, pain, overweight and polyarthralgia often suffer from undiscovered chronic low-grade inflammation. There is a great need for effective anti-inflammatory treatment other than the use of painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs) because of the known adverse events and risks when used long-term. Case Description We present here the cases of three patients with inflammatory conditions including asthenia, obesity, type 2 diabetes, polyarthralgia, psoriatic lesions and knee osteoarthritis. After a comprehensive anamnesis and a quantification of inflammation using C-reactive protein (CRP) as marker, we treated the patients with a sequential approach consisting of diet, exercise and oral enzyme combination (OEC) to identify the effect of each compound of the treatment. The holistic treatment approach used in this report was very effective and is therefore promising in fighting lifestyle associated low-grade inflammation. Conclusions The holistic treatment approach used here, consisting of diet, exercise and OEC, reduced pain, weight, asthenia and inflammation effectively. The patients benefitted greatly from the combined treatment and showed high compliance to OEC with no adverse events reported. Further studies are needed to examine the mechanistic basis of these promising results.
Collapse
Affiliation(s)
- Ettore Pelosi
- Sport Nutrition Department, Multispecialistic Medical Center, CDC-Affidea, Turin, Italy;,PET/CT Nuclear Medicine Department, PET/CT Center, Affidea IRMET, Turin, Italy
| |
Collapse
|
11
|
Kowalska K, Wilczopolski P, Buławska D, Młynarska E, Rysz J, Franczyk B. The Importance of SGLT-2 Inhibitors as Both the Prevention and the Treatment of Diabetic Cardiomyopathy. Antioxidants (Basel) 2022; 11:antiox11122500. [PMID: 36552708 PMCID: PMC9774735 DOI: 10.3390/antiox11122500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/30/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
According to the 2021 report of the International Diabetes Federation (IDF), there have been approximately 573 million cases of type 2 diabetes mellitus (T2DM) among adults, which sets the disease as a major concern in healthcare worldwide. The development of T2DM is strongly promoted by unhealthy lifestyle factors associated with urbanization and western civilization. The disease is associated with a broad list of systemic complications that can result in premature death, disability and significantly reduced quality of life. The most dramatic in their consequences are cardiovascular complications of T2DM. Our work focuses on one such complication that is specific for diabetes, named diabetic cardiomyopathy (DC). In this condition cardiac dysfunction occurs despite the absence of underlying hypertension, coronary artery disease and valvular disease, which suggest a leading role for metabolic disturbances as a cause. We aimed to establish the role of relatively new hypoglycaemic drugs that have taken the medical world by storm with their broad pleiotropic effects-SGLT-2 inhibitors-in the prevention and treatment of DC at any stage.
Collapse
Affiliation(s)
- Klaudia Kowalska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Piotr Wilczopolski
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Dominika Buławska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
- Correspondence: ; Tel.: +48-(042)-639-3750
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| |
Collapse
|
12
|
Butt MD, Ong SC, Wahab MU, Rasool MF, Saleem F, Hashmi A, Sajjad A, Chaudhry FA, Babar ZUD. Cost of Illness Analysis of Type 2 Diabetes Mellitus: The Findings from a Lower-Middle Income Country. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912611. [PMID: 36231911 PMCID: PMC9566593 DOI: 10.3390/ijerph191912611] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND Diabetes is a major chronic illness that negatively influences individuals and society. Therefore, this research aimed to analyze and evaluate the cost associated with diabetes management, specific to the Pakistani Type 2 diabetes population. Research scheme and methods: A survey randomly collected information and data from diabetes patients throughout Pakistan out-patient clinics. Direct and indirect costs were evaluated, and data were analyzed with descriptive and inferential statistics. RESULTS An overall of 1839 diabetes patients participated in the study. The results have shown that direct and indirect costs are positively associated with the participants' socio-demographic characteristics, except for household income and educational status. The annual total cost of diabetes care was USD 740.1, amongst which the share of the direct cost was USD 646.7, and the indirect cost was USD 93.65. Most direct costs comprised medicine (USD 274.5) and hospitalization (USD 319.7). In contrast, the productivity loss of the patients had the highest contribution to the indirect cost (USD 81.36). CONCLUSION This study showed that direct costs significantly contributed to diabetes's overall cost in Pakistan and overall diabetes management estimated to be 1.67% (USD 24.42 billion) of the country's total gross domestic product. The expense of medications and hospitalization mostly drove the direct cost. Additionally, patients' loss of productivity contributed significantly to the indirect cost. It is high time for healthcare policymakers to address this huge healthcare burden. It is time to develop a thorough diabetes management plan to be implemented nationwide.
Collapse
Affiliation(s)
- Muhammad Daoud Butt
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Siew Chin Ong
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Muhammad Umar Wahab
- Consultant Diabetologist, Umar Diabetes and Foot Care Centre, Umar Diabetes Foundation, Office 1, Executive Complex, G8 Markaz, Islamabad 46000, Pakistan
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Fahad Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy & Health Sciences, University of Baluchistan, Quetta 87300, Pakistan
| | - Adnan Hashmi
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Ahsan Sajjad
- Consultant Diabetologist, Umar Diabetes and Foot Care Centre, Umar Diabetes Foundation, Office 1, Executive Complex, G8 Markaz, Islamabad 46000, Pakistan
- Ibn Sina Community Clinic South Wilcrest Drive, Houston, TX 77099, USA
| | | | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield HD1 3DH, UK
| |
Collapse
|
13
|
Sun C, van Soest J, Koster A, Eussen SJPM, Schram MT, Stehouwer CDA, Dagnelie PC, Dumontier M. Studying the association of diabetes and healthcare cost on distributed data from the Maastricht Study and Statistics Netherlands using a privacy-preserving federated learning infrastructure. J Biomed Inform 2022; 134:104194. [PMID: 36064113 DOI: 10.1016/j.jbi.2022.104194] [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: 06/25/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
The mining of personal data collected by multiple organizations remains challenging in the presence of technical barriers, privacy concerns, and legal and/or organizational restrictions. While a number of privacy-preserving and data mining frameworks have recently emerged, much remains to show their practical utility. In this study, we implement and utilize a secure infrastructure using data from Statistics Netherlands and the Maastricht Study to learn the association between Type 2 Diabetes Mellitus (T2DM) and healthcare expenses considering the impact of lifestyle, physical activities, and complications of T2DM. Through experiments using real-world distributed personal data, we present the feasibility and effectiveness of the secure infrastructure for practical use cases of linking and analyzing vertically partitioned data across multiple organizations. We discovered that individuals diagnosed with T2DM had significantly higher expenses than those with prediabetes, while participants with prediabetes spent more than those without T2DM in all the included healthcare categories to different degrees. We further discuss a joint effort from technical, ethical-legal, and domain-specific experts that is highly valued for applying such a secure infrastructure to real-life use cases to protect data privacy.
Collapse
Affiliation(s)
- Chang Sun
- Institute of Data Science, Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands.
| | - Johan van Soest
- Brightlands Institute of Smart Society, Faculty of Science and Engineering, Maastricht University, Heerlen, The Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Simone J P M Eussen
- School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Miranda T Schram
- School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Maastricht Heart & Vascular Center, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Michel Dumontier
- Institute of Data Science, Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
14
|
Mounié M, Costa N, Gourdy P, Latorre C, Schirr-Bonnans S, Lagarrigue JM, Roussel H, Martini J, Buisson JC, Chauchard MC, Delaunay J, Taoui S, Poncet MF, Cosma V, Lablanche S, Coustols-Valat M, Chaillous L, Thivolet C, Sanz C, Penfornis A, Lepage B, Colineaux H, Hanaire H, Molinier L, Turnin MC. Cost-Effectiveness Evaluation of a Remote Monitoring Programme Including Lifestyle Education Software in Type 2 Diabetes: Results of the Educ@dom Study. Diabetes Ther 2022; 13:693-708. [PMID: 35133640 PMCID: PMC8991290 DOI: 10.1007/s13300-022-01207-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/18/2022] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Telemedicine programs using health technological innovation to remotely monitor the lifestyles of patients with type 2 diabetes (T2D) can improve glycaemic control and thus reduce the incidence of complications as well as management costs. In this context, an assessment was made of the 1-year and 2-year cost-effectiveness of the EDUC@DOM telemonitoring and tele-education program. METHODS The EDUC@DOM study was a multicentre randomized controlled trial conducted between 2013 and 2017 that compared a telemonitoring group (TMG) to a control group (CG) merged with health insurance databases to extract economic data on resource consumption. Economic analysis was performed from the payer perspective, and direct costs and indirect costs were considered. The clinical outcome used was the intergroup change in glycated haemoglobin (HbA1c) levels from baseline. Missing economic data were imputed using multiple imputation, and fitted values from a generalized linear mixed model were used to calculate the incremental cost-effectiveness ratio (ICER). Bootstrapped 95% confidence ellipses were drawn in the cost-effectiveness plan. RESULTS The main analysis included data from 256 patients: 126 in the TMG and 130 in the CG. Incremental costs over 1 and 2 years were equal to €2129 and €5101, respectively, in favour of the TMG. Once imputed and adjusted for confounding factors, the TMG trends to a 21% cost decrease over 1 and 2 years of follow-up (0.79 [0.58; 1.08], p = 0.1452 and 0.79 [0.61; 1.03], p = 0.0879, respectively). The EDUC@DOM program led to a €1334 cost saving and a 0.17 decrease in HbA1c over 1 year and a €3144 cost saving and a 0.14 decrease in HbA1c over 2 years. According to the confidence ellipse, EDUC@DOM was a cost-effective strategy. CONCLUSION This study provides additional economic information on telemonitoring and tele-education programs to enhance their acceptance and promote their use. In the light of this work, the EDUC@DOM program is a cost-saving strategy in T2D management. TRIAL REGISTRATION This trial was registered in the Clinical Trials Database on 27 September 2013 under no. NCT01955031 and bears ID-RCB no. 2013-A00391-44.
Collapse
Affiliation(s)
- Michael Mounié
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France.
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France.
| | - Nadège Costa
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France
| | - Pierre Gourdy
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France
| | - Christelle Latorre
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France
| | - Solène Schirr-Bonnans
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France
| | | | - Henri Roussel
- CNAM, DRSM Occitanie, 2 rue Georges Vivent, 31082, Toulouse, France
| | - Jacques Martini
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
- DIAMIP Network, Toulouse, France
| | | | - Marie-Christine Chauchard
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
- DIAMIP Network, Toulouse, France
| | - Jacqueline Delaunay
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
| | - Soumia Taoui
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
| | | | | | | | | | | | | | | | - Alfred Penfornis
- Sud Francilien Hospital, Corbeil-Essonnes, and Paris-Saclay University, Corbeil-Essonnes, France
| | - Benoît Lepage
- Department of Epidemiology, University Hospital, Toulouse, France
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France
| | - Hélène Colineaux
- Department of Epidemiology, University Hospital, Toulouse, France
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France
| | - Hélène Hanaire
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France
| | - Laurent Molinier
- Health-Economic Unit, Medical Information Department, University Hospital, Toulouse, France
- CERPOP, INSERM - University Toulouse III Paul Sabatier, Toulouse, France
| | - Marie-Christine Turnin
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Toulouse, France
| |
Collapse
|
15
|
Alkhatib NS, Almutairi AR, Alkhezi OS, Alfayez OM, Al Yami MS, Almohammed OA. Economic Analysis of glucagon like peptide-1 receptor agonists from the Saudi Arabia Payer Perspective. Saudi Pharm J 2022; 30:433-439. [PMID: 35527835 PMCID: PMC9068523 DOI: 10.1016/j.jsps.2022.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/21/2022] [Indexed: 12/09/2022] Open
Abstract
Objectives To perform a cost of control analysis of glucagon like peptide-1 receptor agonists (GLP1RA) in Saudi Arabia (SA) and determine the economic impact of adopting GLP1RAs. Methods A budget impact model that captures the cost of control model was constructed to simulate hypothetical patient on six treatment options: a current mix of 60% liraglutide and 40% dulaglutide, semaglutide, liraglutide, dulaglutide, exenatide, and lixisenatide. We estimated the relative amounts of SAR spend to achieve HbA1c targets (≤6.5% or < 7.0%). For each treatment option, annual treatment cost, proportion of patients achieving HbA1c targets, and cost to treat major adverse cardiovascular events (MACE) were aggregated to estimate the cost of control per patient per year (CCPPPY) over 5-year horizon (2021–2025). Probabilistic sensitivity analysis (PSA) was performed as a confirmatory analysis. Results The CCPPPY to achieve HbA1c ≤ 6.5%/<7.0% using current mix, semaglutide, liraglutide, dulaglutide, exenatide, and lixisenatide were SAR 17,097/SAR 14,113, SAR 12,889/SAR 11,123, SAR 15,594/SAR 12,892, SAR 19,184/SAR 15,940, SAR 580,211/SAR 380,936, and SAR 246,570/SAR 143,759, respectively. The relative amounts of SAR spend to achieve HbA1c ≤ 6.5%/<7.0% relative to 1 SAR on semaglutide in case of adopting current mix, liraglutide, dulaglutide, exenatide, and lixisenatide were SAR 1.42/SAR 1.18, SAR 1.30/SAR 1.07, SAR 1.60/SAR 1.33, SAR 48.33/SAR 31.73, and SAR 20.54/SAR 11.97, respectively. These results were confirmed in the PSA. Conclusions Semaglutide 1 mg once weekly was the most economically favorable GLP1RA; associated with the least CCPPPY, and amount of SAR spent to achieve HbA1c of ≤6.50%/<7.00% versus all other GLP1RAs.
Collapse
|
16
|
Lis-Kuberka J, Orczyk-Pawiłowicz M. Polish Women Have Moderate Knowledge of Gestational Diabetes Mellitus and Breastfeeding Benefits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910409. [PMID: 34639709 PMCID: PMC8508017 DOI: 10.3390/ijerph181910409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/30/2022]
Abstract
Gestational diabetes mellitus (GDM) is a multifaceted disease and is associated with complications for newborns and mothers. The aim of the study was to assess Polish women’s knowledge concerning GDM and their attitude to breastfeeding. As a research tool, an anonymous online survey that included 33 questions, grouped into three main sections—sociodemographic and obstetric variables, risk factors for GDM and neonatal adverse outcomes, and knowledge about breastfeeding—was used and administered online. A total of 410 women aged from 18 to 45 participated in this study. Based on the survey, it was demonstrated that the women had moderate knowledge concerning the maternal risk factors and adverse neonatal outcomes associated with GDM and, additionally, the short- and long-term effects of breastfeeding. Significantly deeper knowledge about GDM, including breastfeeding by GDM mothers, was observed among hyperglycemic mothers in comparison to normoglycemic mothers. However, knowledge concerning the health benefits of breastfeeding was not related to the mothers’ glycemic status. In conclusion, educational programs must include pre-pregnancy education of women and place emphasis on explaining the mechanism of development of GDM and the transformation of GDM to type 2 diabetes. This is crucial for changing the public’s perception of GDM as a temporary, reversible clinical entity.
Collapse
|
17
|
Gabler M, Picker N, Geier S, Foersch J, Aberle J, Martin S, Riedl M, Wilke T. Real-world clinical outcomes and costs in type 2 diabetes mellitus patients after initiation of insulin therapy: A German claims data analysis. Diabetes Res Clin Pract 2021; 174:108734. [PMID: 33737213 DOI: 10.1016/j.diabres.2021.108734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/04/2021] [Accepted: 02/22/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study describes real-world treatment-related outcomes and healthcare costs of German type 2 diabetes mellitus (T2D) patients who initiated insulin therapy. METHODS This retrospective analysis includes German claims data from 01/01/2012 until 31/12/2016. Identification of eligible patients took place between 01/01/2013 and 31/12/2015, allowing for at least 1 year of follow-up. Clinical outcomes, such as HbA1c values and body mass index, were observed in a subpopulation participating in a Disease Management Program. Healthcare expenditures were evaluated for the first year of therapy. RESULTS Overall, 27,340 insulin starters with T2D were observed (mean age: 72.2 years, female: 51.4%). Treatment-related outcomes were evaluated in a subsample of 12,034 patients. Patients who started insulin combined with other antidiabetic drugs (ADs) achieved their HbA1c goals more frequently than patients on insulin monotherapy (+10.7 percentage points [pp] vs. +21.1 pp for insulin plus metformin). All-cause costs were by far highest among patients with insulin monotherapy (€ 12,283 per patient-year) compared with patients receiving a combined AD regimen (€ 9,947-10,509 per patient-year). CONCLUSIONS Changes in HbA1c values were not in favor of insulin monotherapy, compared to regimens including other ADs. It was also associated with higher costs, suggesting that insulin alone is a suboptimal treatment.
Collapse
Affiliation(s)
- Maximilian Gabler
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Nils Picker
- Ingress-Health HWM GmbH, Alter Holzhafen 19, 23966 Wismar, Germany.
| | - Silke Geier
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Johannes Foersch
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Jens Aberle
- Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany
| | - Stephan Martin
- Westdeutsches Diabetes- und Gesundheitszentrum (WDGZ), Hohensandweg 37, 40591 Düsseldorf, Germany
| | - Matthias Riedl
- Medicum Hamburg MVZ GmbH, Beim Strohhause 2, 20097 Hamburg, Germany
| | - Thomas Wilke
- IPAM, University of Wismar, Alter Holzhafen 19, 23966 Wismar, Germany
| |
Collapse
|
18
|
Lan K, Wang J, Nicholas S, Tang Q, Chang A, Xu J. Is hypoglycemia expensive in China? Medicine (Baltimore) 2021; 100:e24067. [PMID: 33592860 PMCID: PMC7870220 DOI: 10.1097/md.0000000000024067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/04/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND As a common medical emergency in individuals with diabetes, hypoglycemia events can impose significant demands on hospital resources. Based on diabetes patients with and without hypoglycemia, we assess the cost of hypoglycemic events on China's hospital system. METHOD Our study sample comprised 7110 diabetes episodes, including 1417 patients with hypoglycemia (297 patients with severe and 1120 with non-severe hypoglycemia) and 5693 diabetes patients without hypoglycemia. Data on patient social-demographics, length of hospital stay, and hospitalization costs were collected on each patient from Health Information System in Shandong province, China. The additional hospital costs caused by hypoglycemia were assessed by the cost difference between diabetes patients with and without hypoglycemia, including severe and non-severe hypoglycemia. China-wide hospital costs of hypoglycemia were estimated based on adjusted additional hospital costs, comprising inspection, treatment, drugs, materials, nursing, general medical costs, and other costs, caused by hypoglycemia, the prevalence of diabetes and hypoglycemia events, and the rates of hospitalization. Multiple sensitivity analyses were conducted to assess the impact of variations in the key input parameters on the primary estimates. RESULTS Total hospital costs for patients with hypoglycemia (US$3020.61) were significantly higher than that of patients without hypoglycemia (US$1642.91). The average additional cost caused by hypoglycemia was US$1377.70, with higher average costs of US$1875.89 for severe hypoglycemia and lower average costs of US$1244.76 for non-severe hypoglycemia. The additional hospital cost caused by severe and non-severe hypoglycemia patients was higher for the 60 to 75 year old group, married patients and patients accessing free medical services. Generally, hypoglycemic patients with Urban and Rural Resident Basic Medical Insurance incurred higher additional hospital costs than patients with Urban Employees Basic Medical Insurance. Based on these estimates, the total annual additional hospital costs arising from hypoglycemia events in China were estimated to be US$67.52 million. Sensitivity analyses suggested that the costs of hypoglycemia events ranged up to US$49.99 million to 67.52 million. CONCLUSION : Hypoglycemic events imposed a substantial cost on China's hospital system, with certain subgroups of patients, such as older patients and those with free health insurance, using medical resources more intensively to treat hypoglycemia events. We recommend more effective planning of prevention and treatment regimes for hypoglycemia patients; further reform to China's health insurance schemes; and better hospital cost control for those accessing free hospital services.
Collapse
Affiliation(s)
- Kuixu Lan
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan
- The Affiliated Hospital of Qingdao University, Qingdao
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Beijing
- Center for Health Economics and Management at School of Economics and Management, Wuhan University, Wuhan
| | - Stephen Nicholas
- School of Economics and School of Management, Tianjin Normal University, Tianjin
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China
- TOP Education Institute 1 Central Avenue Australian Technology Park, Eveleigh, Sydney
- Newcastle Business School, University of Newcastle, University Drive, Newcastle, New South Wales, Australia
| | - Qun Tang
- The Affiliated Hospital of Qingdao University, Qingdao
| | - Alison Chang
- Department of Anthropology, Princeton University, Princeton, USA
| | - Junfang Xu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|