Disability and cost for diabetic patients at a public district hospital in Thailand

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.     

Fetal alcohol syndrome prevention: annual and cumulative cost savings

Fetal alcohol syndrome (FAS) is a common developmental disability. FAS is thought to be 100% preventable. While this is a theoretical truth, a prevention rate of 100% appears unlikely in the near future. However, several prevention strategies are available. In this paper, we examine the potential cost savings from prevention of one case of FAS each year in the state of North Dakota.

We utilized the North Dakota Health Claims Database to examine annual cost of health care for children birth through 21 years of age with FAS and controls.

The mean annual cost of health care for children birth through 21 years of age with FAS was US$2842 (n=45). This is US$2342 per capita more than the annual average cost of care for children in North Dakota who do not have FAS (US$500 per year).

Prevention of one case of FAS per year in North Dakota would result in a cost savings of US$128,810 in 10 years and US$491,820 after 20 years. After 10 years of prevention, the annual savings in health care costs alone for one case of FAS would be US$23,420.     

Cost of Type 2 Diabetes mellitus in Hong Kong Chinese

OBJECTIVE: Hong Kong (HK) is a special administrative region of China as well as being a metropolitan city. In HK, like in many developed countries, Diabetes mellitus, with over 97% of diabetic patients having Type 2 Diabetes mellitus (Type 2 DM), is a growing public health problem but the local financial burden has never been investigated. The primary objectives of this study were to evaluate from the social perspective the costs of Type 2 DM, to identify the major cost drivers, and the proportion of the burden shared by the government, patient and the society. The study was carried out in a group of Hong Kong Chinese patients attending a government hospital. The economic impact of Type 2 DM on local and governmental healthcare expenditure was also examined. METHODS: A retrospective cohort observational study was conducted in Type 2 DM patients attending the Diabetes Mellitus Outpatient Clinic at a public hospital in the period January 2004 to May 2004, in which 204 patients were randomly selected and invited to join this study. A total of 147 patients were subsequently enrolled giving an inclusion rate of 72%. RESULTS: Annual total cost of Type 2 DM in a patient was US$ 1,725 +/- 2,044 (HK$ 13,457 +/- 15,943) with direct costs accounting for > 87.9%. The government was the major payer with over 78.4% of the total costs. Annual total direct medical costs per patient were US$ 1,492 +/- 1,716 (HK$ 11,638 +/- 13,386) of which the government paid 90.6%. Direct medical costs increased markedly if complications were present. In patients with microvascular or macrovascular complications only, the costs increased 1.1-fold compared to those for patients without complications. If both microvascular and macrovascular complications were present in the same patient, the costs were 1.3-fold higher than in patients without complications. CONCLUSION: Costs of Type 2 DM have a significant impact on the local healthcare budget. It contributed in 2004 up to 3.9% of the total HK healthcare expenditure and 6.4% of the HK Hospital Authority's (public sector) expenditures on health.     

Cost of illness of tuberculosis in Penang, Malaysia

Objective To assess the costs incurred by the public health services and patients as a result of tuberculosis (TB) treatment. Setting The study was conducted in a government hospital located in the northern region of Malaysia. Method Retrospective data were collected from medical records and the patients were observed until the completion of their medication. A pharmacoeconomic evaluation was applied to calculate direct and indirect costs. Main Outcome Measure Direct and indirect costs of tuberculosis treatment in a government health institution. Results Two hundred and one tuberculosis patients were included in the study. Different regimens with various durations of treatments were used. The direct medical and non-medical costs as well as indirect costs were calculated and were found to be as follows: US$61.44 for anti-tuberculosis drugs and supplies, US$28.63 for X-ray examinations, US$28.53 for laboratory tests, US$20.03 for healthcare staff time, US$4.28 for hospitalisation, US$43.20 for overhead costs, US$608.11 for transportation and meals and US$118.78 for time away from work. The cost to the patients constitutes approximately 80% of the total cost of the treatment. Conclusion The cost of treating the illness of tuberculosis per patient was US$916.4. The cost of anti-tuberculosis drugs constituted the highest proportion of the cost to the public health services (31.7%) while the cost to the patient constituted the major proportion of the total cost of the illness (79.4%). The Publisher apologises for the extreme delay in publication of this article.     

糖尿病肾病相关药物研究进展

糖尿病肾病(DN)是糖尿病重要微血管并发症,其病理特征性表现为肾小球周边部位出现嗜酸性K-W结节,是糖尿病性肾病具有诊断意义的改变。但仅出现于约10%～20%的糖尿病性肾病患者。糖尿病性肾病其他病理改变特点包括肾小球基膜增厚,肾小球上皮细胞足突融合以及由于细胞外系膜基质增多所致肾小球增大。疾病晚期可出现肾小管萎缩肾内纤维化。糖尿病病程10年以上者约50%并发糖尿病肾病,每年新增终末期肾病中,糖尿病导致者所占比例逐年增高。近年关于血管紧张素转换酶抑制剂(ACEI)治疗糖尿病肾病的研究较多。其外内皮素拮抗剂等,被认为有一定的肾脏保护作用,基因治疗亦给糖尿病肾病带来新希望。现就有关内容综述如下。     

Critical leg ischaemia in New Zealand: economic cost of amputation versus intravenous iloprost

The purpose of this study was to establish the incidence of surgical amputation for critical leg ischaemia in New Zealand, and estimate the hospital, prostheses and indirect costs of this intervention. The cost of amputations was then compared with the cost of treating such patients with iloprost. The study was retrospective. Individual patient records relating to 1991 for both public and private hospitals were analysed. Unit costs relevant to 1991 were applied to the volume data of patients and procedures to derive total costs. Costs were estimated on an incremental basis taking a societal perspective. Conservative estimates were obtained for hospital costs, prostheses and for production loss (loss of output or productivity). Total cost was $NZ15.9 million (hospital and prosthesis cost $NZ13.1 million, production loss $NZ2.8 million). The total quantified cost per amputation was $NZ23 038 (hospital and prosthesis cost $NZ19 020, production loss $NZ4017). 32% of patients requiring amputations were in the working age group. The theoretical avoidance of amputation by treatment with iloprost resulted in net savings of hospital and prosthetic costs of between $NZ6660 and $NZ8720 per patient. Amputation for critical leg ischaemia is costly and has a high mortality, but for iloprost treatment to be cost effective in a New Zealand hospital setting, patients must be targeted and a success rate of at least 55% achieved in avoidance of amputation and reduction of pain while at rest.     

糖尿病足的预防和护理干预

目的 探讨糖尿病足的预防和护理方法.方法 对2004年7月～2007年4月我院收治的3 5例糖尿病足患者的预防和护理干预措施效果进行回顾性分析.结果 35例患者中痊愈25例(占71.43%),好转4例(占11.43%),手术植皮修补5例(占14.28%),截肢手术1例(占2.85%).结论 糖尿病足的预防和护理关键是控制血糖,加强足部护理,避免危险因素的伤害,加强健康教育,使患者增加自我防护意识,提高生活质量.     

Cross-sectional analysis of adult diabetes type 1 and type 2 patients with diabetic micro­vascular complications from a German retrospective observational study

ABSTRACT

Objective: To obtain epidemiological data on the prevalence of predefined stages of diabetic microvascular complications from a representative cross-section of patients with existing microvascular complications of type 1 or type 2 diabetes in Germany.

Research design and methods: A cross-sectional, retrospective study of medical records of 705 type 1 and 1910 type 2 adult diabetic patients with a diagnosis of retinopathy and/or peripheral neuropathy and/or nephropathy before 2002 and treated in 2002 in Germany.

Results: Of 376 patients with type 1 diabetes having retinopathy, 59.3% had mild or moderate non-proliferative retinopathy without macular oedema, 27.1% had macular oedema, and 13.6% had severe retinopathy without macular oedema. In 862 patients with type 2 diabetes, the distribution of retinopathy/maculopathy classes was 56.8%, 35.5%, and 7.7%, respectively. Of 381 type 1 diabetes patients with observed peripheral neuropathy, 81.4% had sensorimotor neuropathy, 8.9% had diabetic foot conditions, and 9.7% had lower extremity amputa­tions because of diabetes. In 1005 patients with type 2 diabetes, the distribution of neuropathy classes was 78.2%, 12.1%, and 9.7%, respectively. The proportions of patients with renal insufficiency in type 1 and type 2 diabetes groups were 15.3% versus 13.5%, respectively.

Conclusions: The study suggests that there are considerable proportions of patients with progressive stages of microvascular complications related to type 1 and type 2 diabetes in Germany. This underlines the importance of improvement of optimal quality of care and frequent screening for preventing late diabetic microvascular complications and the necessity of effective intervention strategies to tackle this major public health problem.     

The major clinical outcomes of diabetic foot infections: One center experience

Diabetes mellitus with its limb and life-threatening complications such as diabetic foot infection and amputation are increasing at epidemic rates all over the world. The objective of this study was to determine the rate of lower extremity amputation, the risk factors and the bacteriologic profile for diabetic foot lesions. The records of all 84 patients with diabetic foot infections of a large general hospital over a 4-year period were retrospectively included. The most commonly isolated pathogens were Staphylococcus aureus (39%), Pseudomonas aeruginosa (14%), Proteus mirabilis (14%), Escherichia coli (14%), Group B streptococci (12%), and Klebsiella pneumonia (8%). The variables, independently associated with higher foot infections, were inadequate diabetic regulation (93%), peripheral neuropathy (88.1%), peripheral vascular disease (73.8%), smoking (56%), past history of ulcer (28.5%), penetrating injury (20.3%), inadequate foot wear (15%) and Charcot osteoartropathy (10.7%). The general amputation rate was 38.1%. Diabetic foot ulcers and its complication rates including infection, gangrene and lower extremity amputation in Turkey are still high. Preventive care of the foot in patients with diabetes mellitus is extremly important. Therefore early diagnosing of risk factors for diabetic foot infections in the primary care setting and their adequate therapy under multidisciplinary approach should not be neglected.     

Medical cost savings from pentoxifylline therapy in chronic occlusive arterial disease

This article assesses the direct medical cost savings associated with therapeutic dosages of pentoxifylline therapy compared with lower dosages in treating chronic occlusive arterial disease (COAD). The savings accrue from elimination of invasive diagnostic measures or a number of surgical procedures received by patients with COAD during hospital admissions. Findings are based on a secondary analysis of results presented in a previously published report of a population based historical cohort study. Patients in this study were severely enough afflicted by the disease that most were under the care of vascular specialists and many underwent surgery to restore normal blood flow. Costs are based on charges from Medicare expenditures in 4 US states in 1989. A case-mix adjustment procedure was applied and a sensitivity analysis was conducted on key assumptions and variables in the cost savings model. Pentoxifylline therapy reduced average hospital costs per patient by $US1173 per year (1989 dollars). After further adjustment for the costs of outpatient visits, other related drugs and the drug acquisition cost, an overall saving of $US965 would still be realised with a patient who received the full therapeutic dose of pentoxifylline. Sensitivity analysis suggests total annual direct medical cost savings between $US69 and $US3090 per patient. Hence, under the most plausible assumptions regarding choice of procedures, study design and patient population, and considering the possibility that diagnostic and surgical costs are delayed but not prevented, pentoxifylline therapy substantially reduces direct medical costs.     

Comparative costs of ertapenem and piperacillin-tazobactam in the treatment of diabetic foot infections.

PURPOSE: To evaluate potential cost savings, trial data were used to determine the clinical outcomes for i.v. ertapenem given once daily and i.v. piperacillin-tazobactam given every six hours daily in treating diabetic foot infections. METHODS: A cost-minimization analysis (CMA) was conducted on the drug-dosing data of the subset of patients enrolled in a recent double-blind randomized trial who were treated solely as inpatients and were clinically evaluable at fi nal assessment (n = 99). Cost per dose was calculated from (a) average hospital acquisition price per dose for ertapenem ($40.52) or piperacillin-tazobactam ($13.58), (b) average U.S. wages and benefits for labor, based on nine published time-and-motion studies of i.v. antibiotic preparation and administration ($3.10), and (c) consumable supplies, using a 40% discount off the manufacturer list price ($2.90). For each patient, the actual number of antibiotic doses given was multiplied by total cost per dose. RESULTS: There were no significant differences between antibiotic groups with respect to patient demographics, percentage with a severe wound, and mean days of i.v. therapy. Compared with piperacillin-tazobactam, patients treated with ertapenem received significantly fewer mean doses (25.5 versus 7.5; p < 0.0001) and lower antibiotic-related costs ($502.76 versus $355.55, respectively; p < 0.001). The $147.21 difference between groups accounts for approximately 3% of total hospital Medicare reimbursements for these infections. CONCLUSION: A CMA of treatment of diabetic foot infections showed that, compared with piperacillin-tazobactam given four times daily i.v., ertapenem given once daily i.v. was associated with lower drug acquisition and supply costs and less time and labor devoted to preparation and administration of i.v. therapy.     

Assessment of Health Economics in Alzheimer's Disease (AHEAD): treatment with galantamine in Sweden

BACKGROUND: Like other developed countries with aging populations, Sweden is expecting large increases in the prevalence of Alzheimer's disease and corresponding escalations in the cost of care for patients with this disease. Galantamine, a new acetylcholinesterase inhibitor and nicotinic modulator, has proved effective in managing patients with Alzheimer's disease in clinical trials. OBJECTIVE: To estimate the long-term health and economic impact of galantamine from the perspective of the public health payer in Sweden. DESIGN AND SETTING: The Assessment of Health Economics in Alzheimer's Disease (AHEAD) model compares galantamine treatment with no pharmacologic treatment. It consists of a module based on trial data followed by a projection module that uses the trial results to predict the time until patients require full-time care (FTC) or until their death. Forecasts were made for up to 10 years. The model was customised to Sweden by using Swedish resource use profiles obtained from the literature. RESULTS: Galantamine is predicted to reduce the time patients require FTC by almost 10%. Approximately 5.6 patients with mild-to-moderate disease would need to be treated to avoid one year of FTC. This would result in savings averaging 27 436 Swedish kronas (SEK) [3131 euros (EUR)] per patient over 10 years (1998 values). To avoid one year of FTC, 3.9 patients with moderate disease would need to be treated, with savings averaging SEK49 019 (EUR 5594) per patient over 10.5 years. Sensitivity analyses of key parameters, such as proportion of patients needing FTC treated in the community, cost of care in an institution, cost of FTC care in the community, the price of galantamine, and the discount rate, found savings with galantamine would occur under most circumstances. CONCLUSION: Galantamine can increase the time before patients require FTC, and may also lead to savings as treatment costs are offset by reductions in other healthcare expenditures and the costs associated with FTC.     

缺血性糖尿病足病血管外科一站式诊治经验

目的：探讨缺血性糖尿病足病血管外科一站式诊治模式的可行性与治疗效果。方法对2008年1月—2015年12月855例因缺血性糖尿病足病成功施行血管腔内介入治疗患者的病历资料进行回顾性研究。其中2008年1月—2012年12月488例患者为多学科治疗组，接受了多学科协作专业化处置的综合治疗；2013年1月—2015年12月367例患者为一站式治疗组，接受了血管外科一站式诊治。研究两组患者的基线特征，出院时创面完全愈合率，总住院时间及住院总费用的差别。结果两组患者间的基线特征、出院时创面完全愈合率均无明显差异(P>0．05)。但与多学科治疗组比较，一站式治疗组的总住院时间及住院总费用明显下降(P<0．05)。结论对缺血性糖尿病足患者实施血管外科一站式诊治是可行的，且可以显著降低患者的总住院时间和住院总费用。     

Cost of adverse drug reactions in a South Indian tertiary care teaching hospital

In India, very few reports on the cost of adverse drug reactions (ADRs) are available. There is a need to study this aspect of health care in order to understand the economic burden imposed by ADRs. The aim of the current work was to study the costs associated with documented ADRs in a tertiary care teaching hospital. This study was conducted in medical wards of a south Indian tertiary care teaching hospital over a 6-month period. The study protocol was assessed and approved by the institutional ethics committee. A total of 317 ADRs from 246 patients were identified during the study period. The present study used an intensive monitoring method to detect ADRs and assessed an incidence of 32.7% adverse reactions in the monitored group. The causality, severity, predictability, and preventability of the documented ADRs were assessed. The total cost to the hospital due to ADRs was found to be Rs. 1,567,397 (US$36 451). The average cost per patient hospitalized with an ADR was Rs. 4,945 (US$115). The cost per reaction was found to be higher in the Indian context, as the per capita annual expenditure on health in this country is around US$109.     

Cost effectiveness of Becaplermin in the treatment of diabetic foot ulcers in four European countries

OBJECTIVE: The primary objective of this study was to estimate the cost effectiveness of treating diabetic foot ulcers with becaplermin (Regranex) plus good wound care (GWC) compared with GWC alone in a variety of European healthcare settings. A secondary objective was to analyse the effect of different treatment practices on the economics of caring for diabetic foot ulcers. DESIGN AND SETTING: Markov-based simulation study from the perspective of a national health system. METHODS: A 12-month Markov computer simulation model was used to assess the cost effectiveness in 4 European countries of treating diabetic foot ulcers with becaplermin plus GWC versus GWC alone. Transition probabilities were taken from a prospective study of 183 patients and becaplermin efficacy was based on 20-week healing rates in a recent meta-analysis of clinical trials involving 449 patients. Country-specific treatment cost data were collected in collaboration with local economic consultations and combined with the disease model to estimate the incremental cost per ulcer-free month gained. The model was then run using hypothetical low- and high-intensity resource usage profiles to investigate the economics of caring for diabetic foot ulcers. RESULTS: Over the course of 1 year, individuals who received becaplermin plus GWC were, on average, predicted to spend an additional 0.81 months (24% longer) free of ulcers and to experience a 9% lower risk of undergoing a lower extremity amputation than individuals who received GWC alone. Consequently, becaplermin plus GWC was estimated to be net cost saving in Sweden, Switzerland and the UK. In France, the addition of becaplermin was estimated to add $US19 (1999 values) for each additional ulcer-free month gained. There were substantial intercountry differences in treatment practices and the costs of treating diabetic foot ulcers. CONCLUSIONS: Becaplermin may be a cost-effective treatment for neuropathic diabetic foot ulcers in a wide range of European settings. In Sweden, Switzerland and the UK, becaplermin may even be cost saving. Substantial intercountry differences in resource patterns appear, at least partly, to be the logical outcome of differences in unit costs.     

Economic evaluation of ACE inhibitor treatment of nephropathy in patients with insulin-dependent diabetes mellitus in Italy

Diabetic nephropathy is one of the major complications of insulin-dependent diabetes mellitus (IDDM), with proteinuria being the main clinical manifestation of diabetic nephropathy. Most patients who develop overt proteinuria progress to end-stage renal disease (ESRD), usually within 5 to 7 years; ESRD necessitates dialysis or renal transplantation. Although a relationship between blood pressure reduction and delaying of ESRD has been assumed for a long time, only recently has a controlled randomised clinical trial shown that the treatment of diabetic nephropathy with an ACE inhibitor can significantly delay the loss of renal function and, therefore, ESRD. Consistent with the clinical trial on which this economic evaluation was based, the costs and consequences of 2 alternatives were considered: (i) patients subject to blood pressure control with only antihypertensive medication, but without an ACE inhibitor (placebo group) and (ii) patients given ACE inhibitor therapy (captopril group) with similar blood pressure control to the placebo group. This cost-effectiveness analysis was performed from the perspective of the Italian National Health Service [Servizio Sanitario Nazionale (SSN)]. Accordingly, only direct costs related to publicly funded healthcare services were included. The number of dialysis-years avoided (DYA) was the clinical end-point. A 10-year time horizon was considered for the economic evaluation. Captopril therapy was dominant, being at the same time more effective and less costly. The total cost for the captopril alternative during the 10-year period was 21,901,625 Italian lire (L; 1993 values) per patient, while total cost for the placebo alternative was L30,352,590 per patient. Compared with placebo, 20.01 DYA per 100 patients treated were estimated with captopril therapy during the trial period, equivalent to 2.4 months per patient. The robustness of this result was confirmed by sensitivity analysis: for both extremes, captopril remained dominant. This economic evaluation, requested by the Italian Ministry of Health, demonstrated savings in healthcare expenditure with the use of an ACE inhibitor in patients with proteinuria.     

2型糖尿病足高危患者的踝肱指数与糖尿病足的关系

目的：对2型糖尿病足高危患者的踝肱指数和糖尿病足的发生率关系进行分析,同时对相关的危险因素进行探讨,以期对糖尿病足的发生早期采取有效的措施。方法对我院收治的已经确诊的438例2型糖尿病患者进行研究,其中391例为非糖尿病足组,47例为糖尿病足组,所有的患者都要进行糖化血红蛋白、总胆固醇、甘油三酯等生化资料、踝肱指数的检查,对两组的临床检查资料和不同踝肱指数组的糖尿病患者数的差异进行比较。结果两组患者踝肱指数与患者病程、收缩压、糖尿病肾病发生率、视网膜病变发生率呈负相关（P均＜0.01）;不同的踝肱指数和糖尿病足组的患病率比较,踝肱指数和糖尿病足组的患病率类似“U”型分布,踝肱指数＞1.31组中糖尿病足组的患者发病率为18.1%;0.9＜踝肱指数≤1.3组的发病率为26.0%;0.7＜踝肱指数≤0.9组的发病率为32.5%;0.5＜踝肱指数≤0.7组的发病率为47.6%;而踝肱指数≤0.5组中的糖尿病足患者发病率达到64.29%,各组患病率进行比较有明显的差异。结论踝肱指数和糖尿病足呈负相关,踝肱指数减低或是出现异常的升高能对早期糖尿病足的发生进行预测,对踝肱指数异常的糖尿病足高危患者要采用积极有效的干预措施。