The economic burden of diabetic retinopathy in Germany in 2002

Background The aims of our study were to describe the costs associated with diabetic retinopathy (DR), and to evaluate its economic impact in Germany. Methods Forty-one German ophthalmologists, randomly selected from a physicians’ database in Germany, provided information on adult Type 1 and Type 2 diabetic patients with DR (n = 207). This information included socio-demographics, clinical characteristics and resource use during the year 2002. National-level cost estimates were calculated, based on these results and the prevalence data on DR in Germany. Results This study found that costs associated with DR tend to increase as DR progresses, being highest in patients with proliferative DR and lowest in patients with mild, non-proliferative DR. The German statutory health insurance (Gesetzliche Krankenversicherung, GKV) covered two-thirds of the total costs paid by all the payers. The total cost of DR from a societal perspective was calculated at €3.51 bn for the year 2002, and from the GKV perspective amounted to €2.23 bn. Conclusions This study is the first comprehensive study to provide estimates of costs associated with DR in Germany. These costs were estimated to account for approximately 1.5% of the total health-care expenditure in 2002. The work in this paper was presented in part at the 104th Annual Meeting of the German Ophthalmologic Society, 21.9.2006–24.9.2006 in Berlin.     

Treatment of Symptomatic Polyneuropathy With Actovegin in Type 2 Diabetic Patients

OBJECTIVE

To evaluate the efficacy and safety of actovegin in patients with diabetic polyneuropathy.

RESEARCH DESIGN AND METHODS

In this multicenter, randomized, double-blind trial, 567 patients with type 2 diabetes received 20 intravenous infusions of actovegin (2,000 mg/day) (n = 281) or placebo (n = 286) once daily followed by three tablets of actovegin (1,800 mg/day) or placebo three times daily for 140 days. Total symptom score (TSS) of the lower limbs and vibration perception threshold (VPT) were used as coprimary outcome measures, computed as the area under the curve (AUC) from repeated scores and divided by duration of exposure. Secondary end points included individual TSS symptoms, neuropathy impairment score of the lower limbs (NIS-LL), and quality of life (short form [SF]-36).

RESULTS

TSS was significantly improved during actovegin treatment compared with placebo, as assessed by AUC (−0.56 points [95% CI −0.85 to −0.27]; P = 0.0003), and from baseline to 160 days (−0.86 points [−1.22 to −0.50]; P < 0.0001). VPT (five sites per foot) decreased by 3% (95% CI 0–6; P = 0.084) with actovegin than placebo, as assessed by AUC, and by 5% (1–9; P = 0.017) after 160 days. NIS-LL sensory function, as assessed by AUC, was significantly improved with actovegin versus placebo (−0.25 [95% CI −0.46 to −0.04]; P = 0.021), as was the SF-36 mental health domain. There were no differences in the incidence of adverse events between the groups.

CONCLUSIONS

Sequential intravenous and oral actovegin treatment over 160 days improved neuropathic symptoms, VPT, sensory function, and quality of life in type 2 diabetic patients with symptomatic polyneuropathy.Diabetic distal symmetric polyneuropathy (DPN) affects approximately one-third of patients with diabetes (1) and is responsible for substantial morbidity, being associated with excruciating neuropathic pain and foot ulcers leading to amputation (2). Neuropathic pain may affect up to 26% of the diabetic population (3) and can exert a substantial impact on quality of life, particularly through the impairment of sleep and reduced enjoyment of life (4). Several classes of analgesics are effective in the treatment of neuropathic pain, but no more than 40–60% of patients show adequate pain relief on monotherapy (5). Moreover, these drugs are frequently associated with central nervous system side effects and do not slow the progression of the underlying neuropathy (2). Based on the pathogenetic mechanisms of DPN (6), several therapeutic approaches have been developed (2,7,8). These drugs have been designed to favorably influence the pathophysiology of the disorder rather than simply relieve pain. However, despite apparent recent progress, the pharmacologic treatment of chronic symptomatic DPN remains a challenge for the physician (5).Actovegin is a deproteinized hemoderivative produced from calf blood by ultrafiltration that contains low–molecular weight compounds of up to 5,000 Da. Oxygen absorption, oxygen utilization, and cellular energy metabolism are stimulated by actovegin (9). Furthermore, actovegin exerts insulin-like activity, such as stimulation of glucose transport, pyruvate dehydrogenase, and glucose oxidation (10,11). Because of these properties, actovegin has previously been used for treatment of cerebral vascular and degenerative disorders (12,13). In a previous small trial (14), actovegin was shown to improve nerve conduction velocity, allodynia, and subjective well-being after 24 weeks in patients with DPN.Evidence has emerged to suggest that nerve ischemia and hypoxia appear to play a paramount role in the pathogenesis of DPN. Reduced nerve blood flow in experimental DPN may be prevented and corrected by several disease-modifying drugs (6). Against this background, we conducted a randomized, controlled trial to evaluate the efficacy and safety of sequential treatment using 20 intravenous infusions of actovegin (2,000 mg) once daily followed by oral administration (1,800 mg/day) for 140 days.     

“Health inequalities in Armenia - analysis of survey results”

Introduction

This study sought to identify factors associated with health service utilisation by individuals with mental disorders in a Canadian catchment area.

Methods

To be included in the study, participants had to be aged between 15 and 65 and reside in the study location. Data was collected randomly from June to December 2009 by specially trained interviewers. A comprehensive set of variables (including geospatial factors) was studied using the Andersen's behavioural health service model. Univariate, bivariate, and multivariate analyses were carried out.

Results

Among 406 individuals diagnosed with mental disorders, 212 reported using a mental health service at least once in the 12 months preceding the interviews. Emotional problems and a history of violence victimisation were most strongly associated with such utilisation. Participants who were middle-aged or deemed their mental health to be poor were also more likely to seek mental healthcare. Individuals living in neighbourhoods where rental accommodations were the norm used significantly fewer health services than individuals residing in neighbourhoods where homeownership was preponderant; males were also less likely to use services than females.

Conclusions

Our study broke new ground by uncovering the impact of longstanding violence victimisation, and the proportion of homeownership on mental health service utilisation among this population. It also confirmed the prominence of some variables (gender, age, emotional problems and self-perceived mental health) as key enabling variables of health-seeking. There should be better promotion of strategies designed to change the attitudes of males and youths and to deal with violence victimisation. There is also a need for initiatives that are targeted to neighbourhoods where there is more rental housing.