持续葡萄糖监测技术应用于医院就诊糖尿病人群的预算影响分析

目的：目前持续葡萄糖监测技术（continuous glucose monitoring, CGM）在我国各省市的收费及报销情况不尽相同，本研究拟从医院管理者的角度，探讨若CGM报销政策在住院、门诊情景下逐步发生变化，对医院消耗的医保基金管理的影响，为医院医保基金总额控制管理提供科学参考依据。方法：基于医院管理者的角度，以年度治疗1万名糖尿病患者的单家三级医院为例，计算报销政策变化后未来3年（2022—2024年）对医保基金的影响；测算成本主要包括血糖监测项目及耗材费用、门诊就诊费用、住院费用以及急性事件治疗费用。报销现状设定为项目耗材均未报销，并分析CGM报销政策逐步推向住院项目报销、住院耗材报销、门诊项目报销、门诊耗材报销带来的预算影响。结果：对于年治疗1万名糖尿病患者的三级医院，若住院及门诊的CGM耗材项目均获得报销，预计2022—2024年每年医保基金总支出增加25.5～39.4万元，人均支出增加39～60元，整体费用可控。报销CGM会让血糖监测项目及耗材的整体支出一定程度增加，但CGM可提供丰富的血糖波动信息、可视化的TIR达标分析情况，降低因血糖监测或用药调整等需求而住院的...

Budget Impact Analysis of Continuous Glucose Monitoring for the Management of Diabetes

Objective:The reimbursement policies for continuous glucose monitoring(CGM)vary across different provinces and cities in China.This study aims to assess the budget impact of CGM reimbursement on medical insurance from the hospital perspective,considering both inpatient and outpatient scenarios.Methods:A tertiary hospital assuming 10,000 people with diabetes was taken as an example to build up the budget impact model from the hospital administrator perspective.The incremental expenditures of medical insurance fund in the next three years(2022—2024)were calculated to estimate the budget impact brought by policy changes of CGM reimbursement.The model included the cost of glucose monitoring service items and consumables,the cost of outpatient visits,hospitalization costs,and treatment costs of acute complications.We assumed that none of the CGM service items and consumables was reimbursed at first,and the scope of reimbursement followed a stepwise expansion from inpatient service items,inpatient consumables,outpatient service items to outpatient consumables.Results:For a tertiary hospital treating 10,000 diabetes patients yearly,if the CGM service items and consumables are reimbursed in both inpatient and outpatient settings,the annual expenditure of medical insurance fund was expected to increase by CNY 255~394 thousand with an increase of CNY 39~60 per capital in 2022—2024.CGM provides rich data on glucose fluctuations and can potentially reduce the hospitalization caused by poor glucose control.This benefit was translated to a saving of hospitalization cost and treatment cost of inpatient acute events,which was estimated as CNY 160~252 thousand annually.Conclusion:This study found that the reimbursement of CGM resulted in an increase in the expenditure of glucose monitoring items and consumables.However,the regular glucose monitoring could facilitate diabetes management and enable better disease control,which could reduce expenditures in hospitalization and acute complications.