Review of the cost of diabetes complications in Australia, Canada, France, Germany, Italy and Spain

OBJECTIVES: To provide a comprehensive source document on previously published cost data for diabetic complications in Australia, Canada, France, Germany, Italy and Spain for use in a peer-reviewed, validated diabetes model. METHODS: A search for published cost of diabetes complications data was performed in peer-reviewed journals listed in PubMed and health economic conference proceedings from 1994 to March 2005. Where country specific data were not available, we referred to government websites and local cost experts. All costs were inflated to 2003 Euros (E). Major complication costs are presented. RESULTS: First year costs of non-fatal myocardial infarction varied between E19277 in Spain and E12292 in Australia. In subsequent years of treatment, this range was E1226 (France) to E203 (Australia). Angina costs were similar across all four countries: E1716 in Australia; E2218 in Canada; E2613 in France; E3342 in Germany; E2297 in Italy; and E2207 in Spain. Event costs of non-fatal stroke were higher in Canada (E23173) than in other countries (Australia E13443; France E11754; Germany E19399; Italy E6583; Spain E4638). Event costs of end-stage renal disease varied depending on the type of dialysis: in Australia (E17188-27552); Canada (E33811-58159); France (E24608-56487); Germany (E46296-68175); Italy (E43075-56717); and Spain (E28370-32706). Lower extremity amputation costs were: E18547 (Australia); E17130 (Canada); E31998 (France); E22096 (Germany); E10177 (Italy); and E14787 (Spain).CONCLUSIONS: Overall, our search showed costs are well documented in Australia, Canada, France and Germany, but revealed a paucity of data for Spain and Italy. Spanish costs, collected by contacting local experts and from government reports, generally appeared to be lower for treating cardiovascular complications than in other countries. Italian costs reported in the literature were primarily hospitalization costs derived from diagnosis-related groups, and therefore likely to misrepresent the cost of specific complications. Additional research is required to document complication costs in Spain and Italy. Australian and German values were collected primarily by referring to diagnostic related group (DRG) tariffs and, as a result, there may be a need for future economic evaluations measuring the accuracy of the costs and resource utilization in the reported values. These cost data are essential to create models of diabetes that are able to accurately simulate the cumulative costs associated with the progression of the disease and its complications.     

A French cost-consequence analysis of the renoprotective benefits of irbesartan in patients with type 2 diabetes and hypertension

ABSTRACT

Objectives: We performed a cost-consequence analysis in a French setting of the renoprotective benefit of irbesartan in hypertensive type 2 diabetes patients over a 25-year period.

Research design and methods: A previously published Markov model simulated progression from microalbuminuria to overt nephropathy, doubling of serum creatinine, end-stage renal disease and death. Three treatment strategies with analogous blood pressure control were compared: (A) control – conventionally medicated antihypertensive therapy (excluding angiotensin converting enzyme inhibitors, other angiotensin-2-receptor antagonists and dihydropyridine calcium channel blockers) initiated at microalbuminuria; (B) early irbesartan – (300?mg daily added to control, initiated with microalbuminuria) and (C) late irbesartan – (300?mg daily, initiated with overt nephropathy). Probabilities came from the Irbesartan in Reduction of Microalbuminuria-2 study, Irbesartan in Diabetic Nephropathy Trial and other sources. Clinical and economic outcomes were projected over 25 years. Annual discount rates were 3%.

Results: Compared to control, early use of irbesartan added (mean ± standard deviation) 1.51 ± 0.08 undiscounted life years (discounted: 0.94 ± 0.05 years), while late irbesartan added 0.07 ± 0.01 (0.04 ± 0.01) years/patient. Early irbesartan added 1.03 ± 0.06 discounted quality-adjusted life years (QALYs), while late irbesartan added 0.06 ± 0.01 QALYs. Early and late irbesartan treatments were projected to save €22?314 ± 1273 and €6619 ± 820/patient, respectively versus control. Sensitivity analysis showed that even over short time horizons both irbesartan treatments were superior to the control group.

Conclusions: In France, early irbesartan treatment improved quality and length of life and reduced costs in hypertensive patients with type 2 diabetes and microalbuminuria. Late irbesartan therapy is beneficial, but earlier irbesartan leads to better outcomes.     

Estimated prevalence of peripheral neuropathy and associated pain in adults with diabetes in France

ABSTRACT

Objective: To estimate the point prevalence of diabetic peripheral neuropathy (DPN) and pain associated with DPN (pDPN) in French adults with diabetes and compare severity of symptoms across demographic subpopulations.

Design: The participant-administered portion of the Michigan Neuropathy Screening Instrument (MNSI) and selected items of the Brief Pain Inventory (BPI) formed part of a computer-aided telephone survey posed to a representative, random sample of French households from March 1, 2005 to April 30, 2005. Questions from the MNSI and the BPI were used to assess the point prevalence of DPN and pDPN in French adults with self-reported diabetes.

Results: The mean age of the study sample was 68 years (SD = 15), the mean duration of diabetes was 15 years (SD = 12) and 56% of participants were female. The prevalence rates of DPN and pDPN in French adults with diabetes were 11 and 8%, respectively. The average age and diabetes duration of participants with DPN and pDPN were not different from participants in the total sample. Among those participants with pDPN, 35% classified their pain as severe, 49% as moderate, and 17% as mild. The prevalence of DPN was higher in participants with type 1 diabetes (14%) than those with type 2 (9%). Among participants with DPN, 88% with severe pain received pain treatment compared to 71% with moderate pain and 58% with mild pain. The most significant limitation of this study is the lack of validation for administering only a portion of the MNSI, but other limitations include the imprecision associated with self-reported questionnaires, a survey sample that does not include participants with undiagnosed diabetes, and a bias toward elderly participants.

Conclusion: This study concluded that 8% of participants with diabetes in France had pDPN.     

个性化护理对肺癌合并糖尿病患者并发症的影响

目的 分析个性化护理在肺癌合并糖尿病患者并发症中的干预作用.方法 选取2013年8月至2016年8月在本院实施治疗的80例肺癌合并糖尿病患者,随机将患者分成两组,每组患者40例,其中对照组患者实施常规护理,观察组患者实施个性化护理干预,对两组患者的并发症发生率对比分析.结果 对照组患者的并发症发生率为57.5％,观察组为5.0％,和对照组患者相比,观察组患者的临床并发症发生率显著偏低,差异有统计学意义(x2=10.2351,P=0.0258).观察组患者的术后空腹血糖为(7.15±2.03) mmol/L,对照组患者为(9.04±1.43) mmol/L,两组对比差异有统计学意义(P＜0.05).结论 个性化护理在肺癌合并糖尿病患者护理中的应用,有助于显著降低患者的并发症发生率及死亡率,值得推广应用.     

Treatment costs of hepatitis C infection among injection drug users in Canada, 2006-2026

Background

Canadian injection drug users (IDUs) are at high risk of hepatitis C virus infection (HCV). However, little is known about the costs associated with their HCV-related medical treatment. We estimated the medical costs of treating HCV-infected IDUs from 2006 to 2026.

Methods

We employed a Markov model of entry through birth or immigration to exposure-related behaviours or experiences, HCV infection, progression to HCV sequelae and mortality for active and ex-IDUs in Canada. We estimated direct and indirect treatment costs using data from the Ontario Case Costing Initiative (OCCI).

Result

Approximately 137,000 IDUs will suffer from HCV-related disease each year until 2026. Applying the OCCI cost data to the prevalence of HCV-related disease from 2006 to 2026 yielded an estimated cost of $3.96 billion CND to treat HCV-infected IDUs.

Conclusions

Substantial costs are associated with the treatment of HCV-related disease among Canadian IDUs. Given the lack of effective HCV prevention strategies in Canada, we must develop targeted evidence-based responses to prevent HCV transmission and ensure appropriate allocation of medical resources to meet the present and future treatment needs of HCV-infected IDUs.     

Association between mean intraocular pressure,disease stability and cost of treating glaucoma in Canada

SUMMARY

Purpose: A retrospective analysis determined the association between intraocular pressure (IOP) control levels (mean and last IOP) and disease stability, and the association between IOP and yearly treatment cost in primary open angle glaucoma (POAG).

Methods: Data were collected from POAG patients, referred to a tertiary glaucoma clinic. All IOP measurements, visual field mean deviation (VF) scores, physicians’ impressions, and resources used (physician visits, procedures, and medications) were recorded and costed using standard resource unit cost lists from the Ministry of Health's perspective. Patients were categorized by the average VF score of their first three visits [mild (< 5?dB), moderate (≥ 5?dB to < 12?dB) and severe (≥ 12?dB)].Pearson's r quantified the association between IOP control levels and stability, where stability was defined by the physician's subjective impression of the patient's disease. Spearman's ρ was determined to quantify association between mean IOP and yearly treatment cost within VF categories.

Results: Four hundred and eleven charts were reviewed of which 265 were acceptable for analysis. A negative relationship was determined between the probability of reaching stability and mean IOP in all three VF severity groups. Pearson's r was –0.68 (?p < 0.001), –0.72 (?p < 0.001), and –0.52 (?p < 0.001) for the mild, moderate, and severe groups, respectively. A similar correlation was determined between the last measured IOP and stability. Pearson's r was –0.49 (?p < 0.001), –0.80 (?p < 0.001), and –0.65 (?p < 0.001) for the mild, moderate and severe groups, respectively. A positive relationship was reported between mean yearly costs and IOP. Spearman's ρ between mean yearly costs and mean IOP was 0.11 (?p = 0.28), 0.23 (?p < 0.05), and 0.26 (?p < 0.05) for each respective VF level.

Discussion and conclusion: Lower IOP control levels are associated with higher probabilities of stability. In addition, lower IOP control levels are associated with lower costs of managing POAG in patients either with moderate VF loss or with severe VF loss. Economic burden increased with increasing disease severity.     

A Markov modelled pharmacoeconomic analysis of bimatoprost 0.03% in the treatment of glaucoma as an alternative to filtration surgery in Italy

ABSTRACT

Objective: Glaucoma is generally managed by decreasing the intraocular pressure (IOP) to a level believed to prevent further damage to the optic disc and loss of visual field. This may be achieved medically or surgically. The objective of this pharmacoeconomic analysis was to investigate the 4‐year costs of bimatoprost 0.03% (Lumigan) eye drops as an alternative to filtration surgery (FS) for glaucoma patients on maximum tolerable medical therapy (MTMT).

Research design and method: A Markov model was designed using effectiveness and resource use data from a randomized clinical trial and expert statements (Delphi panel). The RCT covered 83 patients on MTMT. The model compared bimatoprost with FS. In the bimatoprost model arm patients began treatment with bimatoprost. If target IOP (–20%) was not reached using medical therapy the patient proceeded with FS. In the FS model arm, FS was performed after the first ophthalmologist visit. Unit costs were obtained from an Italian chart and tariffs review (healthcare sector perspective).

Results: The RCT showed that 74.7% of the patients delayed the need for FS by 3 months. The Markov model forecasted that 64.2% of the patients could delay the need for FS by 1 year, and forecasted 34.0% could avoid FS after 4 years. The 4‐year cost per patient in the bimatoprost and FS arms was €3438 and €4194, respectively (incremental costs of €755). The major cost drivers for the bimatoprost arm were patients who needed combination therapy or FS if the target IOP was not reached. In the FS arm, the major cost drivers were the initial surgery costs and pressure-lowering medications used as add-on therapy after FS.

Conclusions: The analysis shows that in a 4‐year perspective bimatoprost is cheaper compared to FS. In addition, the postponement of FS associated with bimatoprost may have important implications for waiting list planning.     

Predictors of publication productivity among hospital pharmacists in France and Quebec

Objective

To describe publications by hospital pharmacists in France and Quebec and evaluate factors predictive of publication productivity.

Method

Variables related to scientific publication productivity were identified through a search of the literature and organized into 4 themes (ie, personal and professional characteristics, hospital activities, research and publishing activities, publication-related motivations and perceptions). A questionnaire was developed that included short-answer items and 58 multiple-choice questions to determine respondents'' level of agreement with statements about their motivations and perceptions surrounding publishing.

Results

Four hundred twenty-two hospital pharmacists (218 respondents from France and 204 from Quebec) were recruited. Respondents from France were more prolific than those from Quebec, even when considering factors such as time worked and gender. Furthermore, the percentage of respondents working in a university health center was lower in France than Quebec (46% vs. 70%, p = 0.001), as was the percentage of respondents indicating a mastery of English (43% vs. 88%, p = 0.001).

Conclusion

Seven factors were predictive of the number of publications per respondent in France and Quebec: practicing hospital pharmacy in France, being male, having academic duties or a PhD, having participated in a clinical trial, having secured funding in one''s own name for a research project, and allocating a greater number of hours per week to research.     

Cost effectiveness of using carboxymethylcellulose dressing compared with gauze in the management of exuding venous leg ulcers in Germany and the USA

ABSTRACT

Objective: To assess the cost effectiveness of using carboxymethylcellulose dressing (CMCD; Aquacel Hydrofiber) compared to gauze in the management of exuding venous leg ulcers in Germany and the USA.

Design and setting: This was a modelling study performed from the perspective of payers (i.e. the sickness funds in Germany and the community sector in the USA).

Methods: Clinical outcomes attributable to managing exuding venous leg ulcers were obtained from the published literature in the English language. These data were combined with resource utilisation estimates derived from a panel of clinicians enabling us to construct two decision models depicting the management of venous leg ulcers with CMCD or gauze over 18?weeks in Germany and the USA. The models were used to estimate the cost effectiveness of CMCD compared to gauze in the management of exuding venous leg ulcers in both countries.

Main outcome measures and results: Starting treatment with CMCD instead of gauze in both Germany and the USA is expected to heal 30% of ulcers within 18?weeks compared to 13% with gauze (?p = 0.003). The healthcare cost of starting treatment with CMCD or gauze in Germany is expected to be €2020 and €2654 respectively at 18?weeks. Additionally, the healthcare cost of starting treatment with CMCD or gauze in the USA is expected to be $3797 and $5288 respectively at 18?weeks. Hence, using CMCD instead of gauze is expected to increase the probability of healing within 18?weeks by 130% and reduce healthcare costs by at least 24%. The healthcare cost of managing CMCD-treated patients was less than that of gauze-treated patients in both countries due to decreased nursing and physician costs associated with a lower frequency of CMCD dressing changes compared to gauze dressing changes. If it were assumed that treatment with gauze in both countries heals 30% of ulcers within 18?weeks (i.e. is identical to CMCD), then the expected healthcare cost of using gauze would be reduced by only 3% (from €2654 to €2562 in Germany and from $5288 to $5148 in the USA).

Conclusion: Within the limitations of our model, starting management of an exuding venous leg ulcer with CMCD instead of gauze is the cost effective strategy in both Germany and the USA. Moreover, the purchase price of a leg ulcer dressing should not be used as an indication of the cost effectiveness of a given method of care.     

The epidemiology,economic burden,and pharmacological treatment of chronic low back pain in France,Germany, Italy,Spain and the UK: a literature-based review

Objective: This study's objective was to review the literature on the epidemiological and economic burden and treatment of chronic low back pain (CLBP) in France, Germany, Italy, Spain and the UK. Methods: A literature search was conducted for 1997 – 2007, focusing on CLBP burden and treatment in the countries of interest. Results: The literature search yielded 1552 articles; 23 sources were included in this review. General population prevalence estimates for CLBP were available for two countries: 5.91% (Italy) and 6.3 – 11.1% (UK). Resource utilization estimates were available for Germany, Italy, Spain and the UK. Patients visited general practitioners and osteopaths. Annual direct costs of low back pain were available only for Germany: > € 7000 per person. Work absenteeism accounted for 75% of the total per-patient cost of low back pain in Germany. The five identified treatment guidelines recommended a multimodal approach. Recommended pharmacotherapies included NSAIDs, muscle relaxants, analgesics and anesthetics, and opioids. Conclusions: Prevalence estimates varied, possibly owing to differences in diagnostic criteria and populations studied. Little is known about CLBP's economic burden. Treatment guidelines recommended multimodal treatment.     

妊娠期糖尿病系统诊治对孕产妇并发症的影响

目的：观察妊娠期糖尿病系统诊治对孕产妇并发症的影响。方法选取2012年1月～2013年12月收治的妊娠期糖尿病患者92例,随机分为观察组45例和对照组47例,对照组未给予任何干预治疗措施,观察组给予早期系统干预诊治,观察并比较两组妊娠结局和母婴并发症情况。结果观察组患者围生期妊娠高血压、羊水过多、产后出血、胎儿窘迫等并发症发生率及新生儿窒息、新生儿低血糖、新生儿高胆红素血症、死亡等并发症发生率均明显少于对照组,差异具有统计学意义（P＜0.05）;观察组剖宫产17例,剖宫产率37.8%,对照组剖宫产24例,剖宫产率51.1%,差异具有统计学意义（P＜0.05）。结论给予妊娠期糖尿病合理有效系统的治疗,对减少孕产妇及新生儿并发症、降低剖宫产率具有重要意义。     

Cost-effectiveness of insulin aspart compared to human insulin in pregnant women with type 1 diabetes in the UK

ABSTRACT

Objectives: In women with type 1 diabetes, poor glycaemic control during pregnancy is associated with high risk of pre-term delivery, perinatal mortality and morbidity. This economic analysis utilises clinical effectiveness data from the Insulin Aspart Pregnancy Study Group Trial to assess costs and outcomes associated with insulin aspart (IAsp) and human insulin (HI) as part of a basal-bolus insulin regimen in pregnant women with type 1 diabetes in the UK.

Research design and methods: Women with type 1 diabetes were enrolled if ≤?10 weeks pregnant or planning to become pregnant, and had HbA_1c ≤?8% at confirmation of pregnancy. Subjects were randomised to treatment with IAsp or HI in a basal-bolus regimen with NPH insulin, with doses titrated according to American Diabetes Association guidelines. An effectiveness endpoint, retrospectively defined for this analysis, was the percentage of women with a live birth at term (≥37 weeks’ gestation). We considered costs of insulin, adverse events, delivery, and neonatal care for pre-term infants. Expected need for neonatal care was estimated from gestational age, using data from the literature and a large UK hospital. Costs were calculated from the perspective of the UK National Health Service.

Results: A total of 322 pregnant women were enrolled in the study and the outcome of pregnancy was known for 302, 151 in each arm. More women experienced a live birth at term with IAsp (72.8%) than with HI (60.9%), difference 11.9% (95% CI 2.0%, 22.5%, p?=?0.028). Mean cost per woman was £3222 for IAsp and £3539 for HI, difference ?£318 (95% CI ?£1353, £576; p?=?0.49).

Conclusions: Compared with HI, the use of IAsp in pregnant women with type 1 diabetes resulted in more live births at term, without increasing total costs of treatment. A prospectively defined study is required to confirm these conclusions.     

Direct costs and health-related resource utilisation in the 6 months after insulin initiation in German patients with type 2 diabetes mellitus in 2006: INSTIGATE study*

ABSTRACT

Objective: To assess direct costs and describe resource utilisation associated with the first 6 months of insulin therapy in German patients with type 2 diabetes mellitus (DM).

*Results were presented as a poster at the 43rd Congress of the German Diabetes Society, 30?Apr–3?May, 2008, Munich, Germany

Research design and methods: This is an ongoing pan-European, non-interventional, prospective study observing the normal course of diabetes therapy of adult patients with type 2 DM in a diabetologic practice setting, and initiating insulin therapy in 2006. Diabetes therapy 6 months prior to initiation of insulin therapy was assessed retrospectively. For German patients (n?=?256), direct costs associated with health-care resource utilisation prior to and after the insulin initiation were assessed and compared from the German statutory health insurance perspective.

Results: The percentage of patients using blood glucose monitoring increased from 76.4 to 99.6%; 42.1% of patients remained on oral anti-diabetic medication, with metformin used most frequently (36.5%). Total average cost of resource use related to diabetes care per patient for the 6-month period prior to and 6 months after insulin initiation increased from [euro]579 to [euro]961. Mean total costs of diabetes care during 6 months after insulin initiation in the subgroup of obese patients with worse prognosis at baseline (HbA_1c?≥?7.5% and BMI?≥?30?kg/m2) were [euro]1047 [95% CI 965; 1128] vs. [euro]903 [95% CI 840; 965] in other patients.

Conclusions: Resource utilisation and costs related to diabetes increased in the 6 months following insulin initiation, mainly driven by specialist care resource use, insulin, and blood glucose monitoring. Total direct costs of diabetes care of the patients with a less favourable profile of BMI and HbA_1c at baseline are higher compared to other patients.