糖尿病性肾病治疗的成本—效果分析

１９９６年荷兰实施了医疗保健方面的质量保证方案，临床专业人员，病人组织和医疗服务调研人员三方以病情为基础。结合成本－效果分析。订立指导方针，并对Ⅰ型和Ⅱ型糖尿病性肾病的预防和治疗作了成本一效果考察。     

1991—1996年天津市慢性病综合干预项目成本—效？…

１９９１～１９９６年天津市在社区开展以人群为目标的慢性病预防与控制综合干预项目。本研究以该项目为基础进行卫生经济学评价，研究结果表明：１９９１～１９９６年贴现（３％）的累积成本为１６１０８８５６元，干预实现三年后，效益－成本比开始大于１，干预时间越长，效果越好，干预措施对脑卒中的干预效果优于冠心病。１９９１～１９９６年由于开展项目累积增加的ＱＡＬＹｓ为１２７５８，每１ＱＡＬＹ成本为９８３元，效益－     

胰岛素类似物治疗2型糖尿病成本-效果分析

为了比较不同药物治疗方案治疗2型糖尿病产生的经济效果,从某一侧面表明了早期应用胰岛素类似物治疗2型DM的可行性、必要性。笔者运用药物经济学成本-效果分析方法,比较两种方案治疗糖尿病的疗效、直接医疗费用和间接费用,并以最小成本分析法进行药物经济学评价。从成本一效果分析看,B组成本-效果比最低,优于其他方案,为最佳方案。     

早期2型糖尿病肾病患者社区综合干预效果分析

目的 探讨早期2型糖尿病肾病患者社区综合干预方案的实施效果.方法 对社区2型糖尿病在册管理对象中选择符合早期糖尿病肾病期诊断标准,且自愿参加的患者80例作为研究对象,实施肾病早期综合干预方案.干预12个月后对血压、空腹血糖、糖化血红蛋白、血脂及尿微量白蛋白指标进行效果评价.结果 研究对象经综合干预后其相关检测指标均比干预前有好转,经t检验分析：尿微量白蛋白、TG、HDL和LDL四项指标前后差异有极显著性意义（P＜0.01）;收缩压、舒张压、FBG、HbAlc、TL及BMI六项指标前后差异有显著性意义（P＜0.05）.结论 本研究反映在社区卫生服务中心对糖尿病伴发早期肾病患者开展综合干预是可行有效的,对控制早期糖尿病肾病患者病情的发展具有重要的影响.     

安徽省学龄儿童口腔疾病综合干预项目卫生经济学评价

目的 评价安徽省7~9岁学龄儿童窝沟封闭试点项目卫生经济学效果，为推动儿童口腔疾病综合干预项目提供参考。方法 利用安徽省2017年度儿童口腔疾病综合干预项目资料，通过建立决策树模型对4万名适龄儿童13万颗第一恒磨牙窝沟封闭效果进行成本效果与成本效益分析，并采用单因素敏感性分析评价模型稳定性。结果 研究显示每避免1名儿童患龋需花费221.53元，成本效益比为1.24；每避免一颗龋齿发生需花费89.57元，成本效益比为1.21。单因素敏感性分析显示当每名儿童干预总成本超过164.51元时，现行干预策略将不再具有经济学效益。结论 安徽省学龄儿童口腔疾病综合干预项目经济学效益良好，建议今后在经济条件允许的地区逐步扩大窝沟封闭干预范围并加强干预项目经济学评价，为政府评价省内各地区干预项目工作效率及确定是否继续或扩大购买、推广该公共卫生服务提供决策依据。     

我国2型糖尿病及糖尿病肾病的经济负担现状

目的:掌握目前中国2型糖尿病伴随慢性肾病的经济负担。方法:在中英文医学文献数据库中检索与2型糖尿病和糖尿病肾病相关的文献,进行综述。结果:中国2型糖尿病及其并发症的经济负担沉重,2007年总经济成本为2478亿元;不同地区经济负担存在差异,农村糖尿病经济负担增加;直接经济负担与间接经济负担的比值为1:0.35。结论:建议重视糖尿病的经济负担问题,应重点关注农村地区、患有严重糖尿病肾病的人群,经济负担研究水平仍然有待提高。     

糖尿病血液透析的护理干预措施

目的：探讨糖尿病血液透析的护理干预措施；方法：对2010年1月至2014年1月在我院进行糖尿病血液透析的36例糖尿病肾病患者的临床护理资料进行回顾性分析；结果：采取合理的护理干预措施后患者的血糖值和SDS评分显著降低，与护理前相比差异具有显著性（P<0.05）；结论：根据糖尿病血液透析患者的实际情况进行护理干预，能够有效增强护理效果，提高患者生命质量。     

糖尿病肾病动物模型研究进展

糖尿病是一种慢性代谢紊乱疾病,糖尿病肾病是糖尿病患者的晚期并发症.可靠的糖尿病肾病动物模型是研究糖尿病肾病发生机制及新的干预措施的重要手段.链脲菌素诱导是研究糖尿病肾损害发生机制和治疗干预措施的重要手段.NOD小鼠是研究较深入的1型糖尿病肾病基因模型,db/db小鼠是研究最深入的2型糖尿病基因模型.     

糖尿病预防的卫生经济学分析研究进展

糖尿病的患病率在全球逐年增长，众所周知，糖尿病是一严重危害人们身心健康的慢性疾病，糖尿病及其并发症给社会及家庭带来沉重的经济负担。疾病干预或预防是使用现有的经济资源使将来获得效益。利用卫生经济学指标对糖尿病防治干预模式进行有效性和成本效益分析，探求最优的糖尿病防治干预模式，寻找具有推广价值的规范化医疗方案，最终为政府部门制定最优的卫生资源有效配置的相关政策提供最有价值的数据及依据，成为卫生工作人员迫在眉睫的研究课题。     

30例II型糖尿病并发肾病患者的临床特点及护理干预措施

目的 探讨护理干预在II型糖尿病并发肾病患者中的临床应用.方法 整理分析我院30例II型糖尿病并发肾病患者,进行系统的护理干预,评价患者对于饮食运动疗法的理解、用药的依从性及相关并发症发生率的情况.结论 II型糖尿病并发肾病患者护理工作中,以基础医疗为前提,采取系统的护理干预措施,能增加患者的依从性,减少相关并发症的发生,延缓糖尿病肾病的进展,提高患者的生活质量.     

Targeting Diabetes Prevention to More Disadvantaged Groups Improves Cost-Effectiveness: Implications of Inequality in Type 2 Diabetes From Theoretical Interventions

ObjectivesTo determine the effect of socioeconomic status on efficacy and cost thresholds at which theoretical diabetes prevention policies become cost-effective.MethodsWe designed a life table model using real-world data that captured diabetes incidence and all-cause mortality in people with and without diabetes by socioeconomic disadvantage. The model used data from the Australian diabetes registry for people with diabetes and the Australian Institute of Health and Welfare for the general population. We simulated theoretical diabetes prevention policies and estimated the threshold at which they would be cost-effective and cost saving, overall, and by socioeconomic disadvantage, from the public healthcare perspective.ResultsFrom 2020 to 2029, 653 980 people were projected to develop type 2 diabetes, 101 583 in the least disadvantaged quintile and 166 744 in the most. Theoretical diabetes prevention policies that reduce diabetes incidence by 10% and 25% would be cost-effective in the total population at a maximum per person cost of Australian dollar (AU$) 74 (95% uncertainty interval: 53-99) and AU$187 (133-249) and cost saving at AU$26 (20-33) and AU$65 (50-84). Theoretical diabetes prevention policies remained cost-effective at a higher cost in the most versus least disadvantaged quintile (eg, a policy that reduces type 2 diabetes incidence by 25% would be cost-effective at AU$238 [169-319] per person in the most disadvantaged quintile vs AU$144 [103-192] in the least).ConclusionsPolicies targeted at more disadvantaged populations will likely be cost-effective at higher costs and lower efficacy compared to untargeted policies. Future health economic models should incorporate measures of socioeconomic disadvantage to improve targeting of interventions.     

Economic evaluation of lifestyle interventions for preventing diabetes and cardiovascular diseases

Lifestyle interventions (i.e., diet and/or physical activity) are effective in delaying or preventing the onset of diabetes and cardiovascular disease. However, policymakers must know the cost-effectiveness of such interventions before implementing them at the large-scale population level. This review discusses various issues (e.g., characteristics, modeling, and long-term effectiveness) in the economic evaluation of lifestyle interventions for the primary and secondary prevention of diabetes and cardiovascular disease. The diverse nature of lifestyle interventions, i.e., type of intervention, means of provision, target groups, setting, and methodology, are the main obstacles to comparing evaluation results. However, most lifestyle interventions are among the intervention options usually regarded as cost-effective. Diabetes prevention programs, such as interventions starting with targeted or universal screening, childhood obesity prevention, and community-based interventions, have reported favorable cost-effectiveness ratios.     

Cost-effectiveness of prevention: opportunities for public health policy in the Netherlands

OBJECTIVE: To gain insight into the cost-effectiveness of new preventive interventions. DESIGN: Systematic review and interviews. METHOD: Based on literature search, a search of the project database of ZonMw and interviews with experts, the National Institute for Public Health and the Environment drew up a long list of preventive interventions that are potentially cost-effective but are not yet systematically carried out in the Netherlands. From this long list, 21 interventions were selected for each of which, at least 3 economic evaluations were available that indicate favourable cost-effectiveness (< Euro 20,000,--per QALY gained). RESULTS: The majority of the interventions concerned vaccination and screening programmes (7 and 5 respectively). Only a small minority concerned health promotion or health protection (1 respectively 3). There was strong evidence that 5 interventions were both cost-effective, and feasible. These were: screening for Chlamydia, screening for diabetic retinopathy in type 2 diabetes, screening for neonatal group beta streptococcal infections through a combination strategy, prevention of recurrent myocardial infarction through heart habilitation, and prevention of head injuries by wearing of bicycle helmets by children. CONCLUSION: Before implementation of preventive interventions, it is necessary to investigate whether these interventions are also cost-effective in the Dutch context.     

The impact of diabetes prevention on labour force participation and income of older Australians: an economic study

Background  

Globally, diabetes is estimated to affect 246 million people and is increasing. In Australia diabetes has been made a national health priority. While the direct costs of treating diabetes are substantial, and rising, the indirect costs are considered greater. There is evidence that interventions to prevent diabetes are effective, and cost-effective, but the impact on labour force participation and income has not been assessed. In this study we quantify the potential impact of implementing a diabetes prevention program, using screening and either metformin or a lifestyle intervention on individual economic outcomes of pre-diabetic Australians aged 45-64.     

Modelling the Economics of Type 2 Diabetes Mellitus Prevention: A Literature Review of Methods

Our objective was to review modelling methods for type 2 diabetes mellitus prevention cost-effectiveness studies. The review was conducted to inform the design of a policy analysis model capable of assisting resource allocation decisions across a spectrum of prevention strategies. We identified recent systematic reviews of economic evaluations in diabetes prevention and management of obesity. We extracted studies from two existing systematic reviews of economic evaluations for the prevention of diabetes. We extracted studies evaluating interventions in a non-diabetic population with type 2 diabetes as a modelled outcome, from two systematic reviews of obesity intervention economic evaluations. Databases were searched for studies published between 2008 and 2013. For each study, we reviewed details of the model type, structure, and methods for predicting diabetes and cardiovascular disease. Our review identified 46 articles and found variation in modelling approaches for cost-effectiveness evaluations for the prevention of type 2 diabetes. Investigation of the variables used to estimate the risk of type 2 diabetes suggested that impaired glucose regulation, and body mass index were used as the primary risk factors for type 2 diabetes. A minority of cost-effectiveness models for diabetes prevention accounted for the multivariate impacts of interventions on risk factors for type 2 diabetes. Twenty-eight cost-effectiveness models included cardiovascular events in addition to type 2 diabetes. Few cost-effectiveness models have flexibility to evaluate different intervention types. We conclude that to compare a range of prevention interventions it is necessary to incorporate multiple risk factors for diabetes, diabetes-related complications and obesity-related co-morbidity outcomes.     

Estimating the cost-effectiveness of lifestyle intervention programmes to prevent diabetes based on an example from Germany: Markov modelling

Background

Type 2 diabetes mellitus (T2D) poses a large worldwide burden for health care systems. One possible tool to decrease this burden is primary prevention. As it is unethical to wait until perfect data are available to conclude whether T2D primary prevention intervention programmes are cost-effective, we need a model that simulates the effect of prevention initiatives. Thus, the aim of this study is to investigate the long-term cost-effectiveness of lifestyle intervention programmes for the prevention of T2D using a Markov model. As decision makers often face difficulties in applying health economic results, we visualise our results with health economic tools.

Methods

We use four-state Markov modelling with a probabilistic cohort analysis to calculate the cost per quality-adjusted life year (QALY) gained. A one-year cycle length and a lifetime time horizon are applied. Best available evidence supplies the model with data on transition probabilities between glycaemic states, mortality risks, utility weights, and disease costs. The costs are calculated from a societal perspective. A 3% discount rate is used for costs and QALYs. Cost-effectiveness acceptability curves are presented to assist decision makers.

Results

The model indicates that diabetes prevention interventions have the potential to be cost-effective, but the outcome reveals a high level of uncertainty. Incremental cost-effectiveness ratios (ICERs) were negative for the intervention, ie, the intervention leads to a cost reduction for men and women aged 30 or 50 years at initiation of the intervention. For men and women aged 70 at initiation of the intervention, the ICER was EUR27,546/QALY gained and EUR19,433/QALY gained, respectively. In all cases, the QALYs gained were low. Cost-effectiveness acceptability curves show that the higher the willingness-to-pay threshold value, the higher the probability that the intervention is cost-effective. Nonetheless, all curves are flat. The threshold value of EUR50,000/QALY gained has a 30-55% probability that the intervention is cost-effective.

Conclusions

Lifestyle interventions for primary prevention of type 2 diabetes are cost-saving for men and women aged 30 or 50 years at the start of the intervention, and cost-effective for men and women aged 70 years. However, there is a high degree of uncertainty around the ICERs. With the conservative approach adopted for this model, the long-term effectiveness of the intervention could be underestimated.     

Cost-effectiveness of alternative interventions for the prevention and treatment of coronary heart disease

Abstract: Although mortality from coronary heart disease (CHD) in Australia has fallen dramatically since the 1960s, it still remains the major cause of death in Australia and poses a significant burden on the economy. Even though a number of studies have concluded that prevention has been the main determinant of the declines in CHD, a disproportionate amount of health-care expenditure is devoted to treatment rather than prevention. This paper reviews the international literature on the economic appraisal (costs and benefits) of alternative interventions for the treatment and prevention of CHD with the view of assessing whether there is sufficient evidence to justify a reallocation of resources away from treatment to prevention. First, few studies on the economic evaluation of CHD prevention and treatment programs have been undertaken in Australia, with most being from the United States and Europe. Second, assumptions about the specification, measurement and valuation of costs, and the epidemiological evidence on program effectiveness have varied. Third, health promotion and prevention programs are not necessarily more cost-effective than drug or surgical treatments for CHD. Individual interventions must be judged on their own merits. There is a need for a systematic evaluation of interventions for CHD using primary Australian data to better inform decision making on resource-allocation priorities. Such an evaluation should incorporate economic evaluation techniques.     

儿童青少年肥胖相关健康危险行为共存及模式研究进展

超重肥胖危害着儿童的身心健康, 并且与其成人期高血压和糖尿病等慢性疾病的患病风险增高有关。健康危险行为作为儿童超重肥胖的重要原因, 往往不是单一发生而是表现为多种行为的共存, 且共存的健康效应是协同作用。因此, 提示需要针对健康危险行为综合施策, 同时改善多种可变的行为, 干预措施才可能更具成本效益且能最大限度地扩大影响。通过综述国内外肥胖相关健康危险行为共存及其模式的研究现状, 概述目前研究的不足并讨论未来的研究方向, 为儿童青少年超重肥胖的预防与控制提供研究基础。     

Reducing the Incidence of Type 2 Diabetes Mellitus

The evidence base derived from the research literature has clearly established that type 2 diabetes mellitus may be prevented or delayed through pharmacological interventions and, most efficaciously, through lifestyle interventions. Unfortunately, efforts to translate the research results into programs that may be applied to the clinical or healthcare system setting are lacking. The purpose of this article is 3-fold: (i) to briefly review the results of the major trials conducted in the area of type 2 diabetes; (ii) to outline an approach that may guide the design and development of type 2 diabetes prevention programs for clinical care; and (iii) to present a protocol that may support the process of implementation in the practice setting.The literature review clearly delineates critical type 2 diabetes prevention program outcomes, i.e. modest weight loss, dietary changes, an increase in physical activity level and, in the case of pharmacological interventions, good adherence to medication regimens. Guided by evidence-informed approaches to translation, this article outlines a set of critical program design principles that guide the development of type 2 diabetes prevention programs, and are systematically included and recognized in the programs; these principles are termed the ‘4Ss’: (i) effect size; (ii) program scope; (iii) scalability; and (iv) long-term sustainability in the real-world setting.Based on additional literature that addresses operational feasibility and principles of design and evaluation, this paper describes a protocol that may help healthcare systems and care delivery settings design such prevention programs and successfully document desired impacts that are meaningful to their customers. The protocol is designed to include the total membership of a healthcare system and it systematically allows for the identification and stratification of the risk of developing type 2 diabetes. Individuals are assigned to one of three risk strata: (i) low risk of developing type 2 diabetes; (ii) high risk of developing type 2 diabetes; or (iii) active disease (already diagnosed with type 2 diabetes). The high-risk group is subsequently invited to participate in risk-reduction strategies that are designed to reduce the incidence of type 2 diabetes.     

Primary prevention of cardiovascular disease: cost-effectiveness comparison

OBJECTIVES: The aim of this study was to evaluate the cost-effectiveness of four risk-lowering interventions (smoking cessation, antihypertensives, aspirin, and statins) in primary prevention of cardiovascular disease. METHODS: Using data from the Framingham Heart Study and the Framingham Offspring study, we built life tables to model the benefits of the selected interventions. Participants were classified by age and level of risk of coronary heart disease. The effects of risk reduction are obtained as numbers of death averted and life-years saved within a 10-year period. Estimates of risk reduction by the interventions were obtained from meta-analyses and costs from Dutch sources. RESULTS: The most cost-effective is smoking cessation therapy, representing savings in all situations. Aspirin is the second most cost-effective (euro 2,263 to euro 16,949 per year of life saved) followed by antihypertensives. Statins are the least cost-effective (euro 73,971 to euro 190,276 per year of life saved). CONCLUSIONS: A cost-effective strategy should offer smoking cessation for smokers and aspirin for moderate and high levels of risk among men 45 years of age and older. Statin therapy is the most expensive option in primary prevention at levels of 10-year coronary heart disease risk below 30 percent and should not constitute the first choice of treatment in these populations.