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PDB1 |
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PREVALENCE OF DIABETES
MELLITUS AND TREATMENT PATTERNS BASED ON
CLASSIFICATION OF BODY MASS INDEX AMONG ADULTS
Suh DC1, Choi IS1, Shin HC1, Barone JA1,
Park J2, Vo L1, 1Rutgers University, Piscataway,
NJ, USA, 2Inha University, Incheon, South Korea OBJECTIVE:
To examine
trends of diabetes mellitus (DM) prevalence in
adults and to investigate treatment patterns and
HbA1c control according to their body mass index
(BMI) classification. METHODS:
This study used the
Third National Health and Nutrition Examination
Survey (NHANES III for 1988-1994) and NHANES
2001-2002, representing a national sample of the
non-institutionalized civilian US population.
Study patients were identified if they were ³20
years old, were previously diagnosed with DM by a
physician or is currently using DM therapy
(insulin or a hypoglycemic agent). DM patients
were classified as normal(BMI<25),
overweight(BMI:25-29), or obese(BMI³30). Data were
analyzed using SAS and SUDAAN statistical
software. RESULTS:
The age-adjusted prevalence of
DM significantly increased from 5.4% in 1988-1994
to 7.1% in 2001-2002 (increase of 1.7%: p<0.05).
In 2001-2002, DM was more prevalent in overweight
patients (6.1%) and obese patients (10.5%) than in
normal weight patients (4%). These trends were
similar in 1988- 1994. More DM patients (80% of
overweight and 87% of obese patients) received
treatment in 2001-2002 than during 1988-1994 (70%
and 78%) (increases:p=0.05 respectively). Patients
were treated with oral antihyperglycemics only
most frequently (56%), followed by insulin only
(17%), and with both insulin and an oral agent
(9%). Overall, mean HbA1c decreased from 7.7% (57%
of DM-patients:HbA1c„d7%) in 1988-1994 to 7.5%
(50% of DM-patients:HbA1c„d7%) in 2001-2002
(p=0.24). CONLUSIONS:
Over the past decade, DM
has become more prevalent in US adults, more
overweight and obese DM patients have received
treatment, yet 20% of overall DM patients still
have not received treatment. In 2001-2002, half of
diabetic patients did not control their HbA1c
level and diabetic patients who were obese were
less likely to control their HbA1c compared to
patients who were normal weight..
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PDB2 |
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A POPULATION APPROACH TO
COMPARE DIABETES IN THE US AND IN TAIWAN
Chang HY1, Hsu CC1, Chiang CY1, Hung BS2,
1National Health Research Institutes, Maoli,
Taiwan, 2Bureau of Health Promotion, Taichung,
Taiwan
OBJECTIVE:
Diabetes has been one of the
leading causes of death since 1983. The death rate
increased sharply in past ten years. The mortality
was 44.4 per 100,000 in 2003, about 72% increment
from 25.7, the death rate in 1993. The mortality
in 2003 was almost 10 times of Japan, over three
times of US, and two times of Korea’s mortality.
The purpose of this study is to investigate the
differences of diabetes in the US population and
the Taiwanese population. METHODS:
We used
two national surveys to identify diabetes in the
population, the 1999-2002 NHANES and the 2002
Taiwan Survey on Hypertension, Hyperglycemia and
Hypercholesterolemia. The definition of diabetes
was those (a) who reported to be told to have the
disease; (b) who reported to take medications for
the disease, or (c) with fasting glucose over 126
mg/dL. Their demographic characteristics, lipid
profiles, blood pressures, health behaviors and
complications were compared. Descript statistics
were used to compare the diabetes patients
directly. SUDAAN was used to estimate the design
effect after accounting for the complex survey
scheme. RESULTS:
There were 350 whites, 594
blacks and 478 Taiwanese were identified as
diabetes in the surveys. The average ages for
males were around 55-58 years, while those for
females were 55-65 years. The HbA1c was best
control in US whites. Both white males and females
were under 8%. On the other hand, it was over 8%
for the Taiwanese females and all blacks.
Taiwanese had the lowest BMI and highest DBP among
these three groups of people. The proportions of
exercise, smoking and hypertension in Taiwanese
were the lowest. CONLUSIONS:
The possible
reasons for the differences between these
populations are genetic makeup, public health
education and treatments.
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PDB3 |
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COST OF MANAGEMENT OF TYPE 2
DIABETES MELLITUS IN HONG KONG CHINESE
Chan BS1, Tsang M2, Lee VW1, Lee KK3, 1The
Chinese University of Hong Kong, Hong Kong, China,
2United Christian Hospital, Hong Kong, China, 3The
Chinese University of Hong Kong, Shatin, Hong
Kong, China
OBJECTIVE:
Despite the recent increase in
incidence and prevalence of Type 2 diabetes
mellitus (T2DM) in Hong Kong (HK), the economic
impact of the disease has never been investigated.
This study aimed to estimate the total economic
burden of a group of T2DM patients attending a
public hospital in HK using a bottom-up,
prevalence-based cost-of-illness approach.
METHODS:
A retrospective cohort observational
study was conducted. The direct medical costs
incurred at the public hospital were collected
from a hospital electronic database. The other
costs were estimated using a standard Chinese
questionnaire. The figures obtained were
extrapolated to estimate the total burden for the
whole T2DM population in HK. The study was
conducted from the perspective of a public
hospital. RESULTS:
Two hundred and four
patients with T2DM were randomly selected to join
this study and 147 were subsequently enrolled.
Annual total direct medical cost per patient was
US$1,492 in which the Government was shouldering
90.6%, while the patients only paid for the
remaining 9.4%. Among these, specialist outpatient
clinic visit costs and inpatient costs were the
major cost drivers, which contributed up to 39.6%
and 43.0% of the overall cost paid by the
Government, respectively. The direct medical cost
paid by the Government jumped dramatically, by 1.3
times, if the patient had complications. The total
government direct medical cost for those without
complication was US$1,254/patient/year, which
would jump to US$1,692/patient/year for patients
developing both microvascular and macrovascular
complications.T2DM was found to have significant
impact to the local health care budget. It
contributed to 5.0% of the total HK health care
expenditure and 8.2% of the total Government
healthcare expenditure. CONLUSIONS:
This
study confirmed T2DM and its complications posed a
significant burden on the HK health care budget.
Slowing the progression of the disease to the more
advanced and costly states should be cost-saving.
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PDB4 |
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HEALTH RELATED QUALITY OF
LIFE (HRQOL) IN THAI DIABETIC PATIENTS
Thavorncharoensap M, Pongcharoensuk P,
Chaikledkaew U, Suksomboon N, Mahidol University,
Rajathevi, Bangkok, Thailand
OBJECTIVE:
To assess Health Related Quality of
Life (HRQOL) among patients with diabetes mellitus
in Thailand. METHODS:
Cross-sectional survey was
conducted during September - November 2004. Three
hundred and thirty three patients selected from 5
hospitals in Thailand were interviewed using
Thai-version of the Medical Outcome Study Short
Form (SF-36). Also, utility value was measured
using Visual Analog Scale (VAS). RESULTS:
Average
score on 8 SF-36 subscales ranged from 48.37 (S.D.
= 21.43) in General Health (GH) subscale to 82.05
(S.D. = 22.87) in Social functioning (SF)
subscale. Concerning health transition, as
compared to previous year, patients reported that
their general health was about the same (32.1%),
somewhat worse (29.2%), somewhat better (23.4%),
much better (8.1%), and much worse (7.2%). Utility
value of the patients ranged from 0 to 100 with an
average of 66.59 and the S.D. of 19.57. When
looking at the demographic characteristics, it was
found that those with low income had lower score
on all 8 SF-36 subscales and VAS than the others.
Patients recruited from outpatient department had
higher HRQOL than those recruited from inpatient
department. No significant difference across
gender on their HRQOL and utility value was found
except in the Physical Functioning (PF) subscale.
It was found that male had marginally higher score
in PF subscale than female. No significant
difference in HRQOL and utility value across
smoking status and drinking status was found. For
clinical characteristic, it was found that those
who had co-morbidity had lower score in Physical
Functioning (PF) subscale and Role emotional (RE)
subscale than those who did not have co-morbidity.
CONLUSIONS:
Diabetes Mellitus negatively affects HRQOL of the patients in several domains. Specific
attention should be paid to these patients to
improve their HRQOL especially for the patients
who had low income and those with co-morbidity.
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PDB5 |
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IS DIABETES KNOWLEDGE
ASSOCIATED WITH HEALTH-RELATED QUALITY OF LIFE
AMONG ENGLISH-SPEAKING SUBJECTS WITH DIABETES IN
SINGAPORE?
Zhang XH1, Wee HL2, Tan K3, Tan HH4,
Thumboo J2, Li SC1, 1National University of
Singapore, Singapore, 2Singapore General Hospital,
Singapore, 3Diabetic Society of Singapore,
Singapore, Singapore, 4Singhealth Polyclinics,
Singapore
OBJECTIVE:
To evaluate if diabetes
knowledge is associated with health-related
quality of life (HRQoL)among English-speaking
subjects with diabetes in Singapore. METHODS:
English-speaking subjects (aged >21) with
self-reported diabetes were recruited by
convenience sampling at a public event organized
by Diabetic Society of Singapore to commemorate
the World Diabetes Day. Correlation between
diabetes knowledge (measured using the General
Diabetes Knowledge Test (GDKT), range 0-100) and
HRQoL (measured using the Audit of
Diabetes-dependent Quality of life (ADDQoL), range
0-100; EQ-5D, range –0.594 to 1 and the SF-6D,
range 0.26-1) were studied using Pearson
correlation coefficients. The relationship between
diabetes knowledge and HRQoL was studied using
three separate multiple linear regression (MLR)
models with HRQoL scores as dependent variable and
GDKT score as independent variable while adjusting
for age, gender, ethnicity, education, housing
type, smoking status and presence of acute/
chronic medical conditions and diabetes
complications. RESULTS:
Data from 42
subjects with complete responses were analyzed
(mean (SD) age: 53.0(9.61) years, 45.0% female,
90.0% with >6 years of education, 64.3% with other
chronic medical conditions, 40.5% with diabetes
complications). Mean (SD) GDKT, ADDQoL, EQ-5D and
SF-6D scores were 33.1(3.53), 46.9(18.56),
0.9(0.15) and 0.8(0.14) respectively. Correlations
between diabetes knowledge and ADDQoL, EQ-5D and
SF-6D scores were 0.26, 0.30 and 0.21
respectively. Although none of the independent
variables was associated significantly with HRQoL
scores in any of the MLR models (p>0.05), a trend
of association was nevertheless observed.
CONLUSIONS:
Our results showed diabetes
knowledge to be weakly correlated with both
diabetes-specific and generic health-related
quality of life. In addition, diabetes knowledge
may be positively associated with
diabetes-specific HRQoL but further studies
utilizing larger sample size would be required to
confirm the observation.
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PDB6 |
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OBESITY’S IMPACT ON DIABETES
PATIENTS’ HEALTH-RELATED QUALITY OF LIFE IN THE
U.S.
Cremieux PY1, Xie J2, Greenberg P1, Wu EQ3,
Castor AR1, 1Analysis Group Inc, Boston, MA, USA,
2The University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA, 3Analysis Group, Boston, MA,
USA OBJECTIVE:
To assess obesity’s
impact on the health-related quality of life (HRQL)
of diabetes patients in the U.S. METHODS:
Adults (age >= 18) with diabetes (ICD9CM = 250) in
the 2000 and 2002 Medical Expenditure Panel Survey
(MEPS) were classified as underweight (BMI<18),
normal weight (BMI:18-24.9), overweight
(BMI:25-29.9), or obese (BMI: >=30). Underweight
individuals were excluded from the study sample.
HRQL was assessed using SF-12 physical, SF-12
mental and EQ-5D index scores. These scores were
used to compare obese vs. normal weight and
overweight vs. normal weight populations.
Stratification matching methods were employed to
control for demographic differences between
comparison groups (e.g. age, sex, race, and
geographic location). Differences in HRQL scores
are reported using both absolute difference and
effect sizes (ES). Individual MEPS weights were
used to achieve U.S. nationally representative
estimates. RESULTS:
A total of 2,777 adults
with diabetes are included in the study, of which
497 are of normal weight, 903 are overweight, and
1,377 are obese. SF-12 physical and EQ-5D index
scores for the obese sample were 4.35 and 0.06
lower (4.35% and 6.27%; ES = 0.35 and 0.19,
respectively) than the normal weight sample
(p<.05). All differences reported control for age,
sex, race, and geographic location. There were no
statistically significant differences in the SF-12
mental scores between the obese and normal weight
samples. Similarly, SF- 12 mental, SF-12 physical
and EQ-5D index scores were statistically no
different between the overweight and the normal
weight populations. CONLUSIONS:
Obesity is
associated with a statistically significant
reduction in physical HRQL and overall health
utility among diabetic patients in the United
States but does not seem to affect their mental
health. On the other hand, overweight leaves
physical, mental and overall health utility scores
unchanged relative to a normal weight population.
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PDB7 |
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IMPACT OF OBESITY AND
DIABETES ON HEALTH RELATED QUALITY OF LIFE
Iyer R, University of Appalachia College of
Pharmacy, Grundy, VA, USA How obesity
affects health-related quality-of-life (HRQOL),
particularly in patients with diabetes, is less
clear. OBJECTIVE:
The objective of this study is
to examine the relationship between obesity and HRQOL in diabetic patients. An additional
objective was to examine the difference in total
costs and prescription costs in these patients.
METHODS:
The data for this study came from the
2002 Medical Expenditure Panel Survey. Respondents
> 17 years were classified as normal, overweight
or non-obese based on BMI. HRQOL was measured by
the 12-item Short Form physical and mental summary
scores (PCS-12 and MCS-12, respectively).
Non-diabetic patients greater than 17 years with
demographic characteristics matched to the
diabetic group were used for comparison. Analysis
of variance was used to compare the four study
groups (diabetic/obese, diabetic/non-obese,
non-diabetic/obese, and non-diabetic/non-obese).
Expenditures were adjusted for inflation with the
consumer price index. RESULTS:
The total sample
consisted of 4020 patients. Mean scores for obese
diabetics were lower than mean score for non-obese
diabetics in all eight health-related quality of
life scales. The physical component summary scores
were significantly higher in normal non-diabetic
patients than in obese diabetics (40.145 vs.
34.543, p = 0.0004). The difference in the total
expenditure between normal non-diabetic and
diabetic groups was $3145 (p=0.0007). Expenditure
for prescription medication was significantly
different in the two groups $1594(p = 0.0000).
There was no significant difference in the mental
component summary scores among the four groups.
CONLUSIONS:
Patients with obesity had
significantly lower HRQOL than those who were
normal weight. Counseling for exercise, importance
of nutrition, and optimal management of diabetes
in these patients could improve their quality of
life and reduce the national healthcare spending.
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PDB8 |
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PERCEIVED SELF-EFFICACY
TRAINING (PSET) PROGRAM IN TYPE 2 DIABETES
Suksomboon N1, Poolsup N2, Hoharitanon S3,
Luckanajantachote P3, 1Mahidol University,
Rajathevi, Bangkok, Thailand, 2Silpakorn
University, Nakornprathom, Thailand, 3Samutsakorn
Hospital, Samutsakorn, Thailand OBJECTIVE:
To
evaluate the effects of perceived self-efficacy
training program in type-2 diabetes. METHODS:
A
total of 54 diabetic patients were randomized to
the intervention or control group at primary care
unit, Samutsakhon Hospital, Thailand. Patients in
the intervention group entered perceived
self-efficacy training program, those in the
control group did not. The patients’ perceived
self-efficacy, self-care behaviors, and knowledge
in diabetes were assessed using questionnaires at
the beginning and at three months after entering
the training program. RESULTS:
There were 27
patients in each group. No significant differences
between the two groups were found at the beginning
of the study with respect to perceived
self-efficacy, self-care behaviors, and knowledge
in diabetes. After the program, self-care
behaviors of patients in the intervention group
were better than those in the control group (56.00
± 5.54 points VS 50.85 ± 5.99 points, P = 0.002).
Perceived self-efficacy and knowledge in diabetes
in the intervention group also improved, but not
significantly so, compared to the control group.
CONLUSIONS:
Although the perceived self-efficacy
training program does not affect the perceived
self-efficacy of type-2 diabetes, it significantly
improves their self-care behaviors. It has yet to
be seen as to whether these behaviors are
sustainable and for how long.
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PDB9 |
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COSTS OF DIABETES PATIENTS IN
THAI GOVERNMENT HOSPITALS
Pongcharoensuk P1, Kongsaktrakool B1,
Tantivipanuwong S1, Sema-ngern K1, Chaiyakunapruk
N2, 1Mahidol University, Bangkok, Thailand,
2Naresuan University, Muang, Phitsanulok, Thailand
OBJECTIVE:
To determine direct medical cost of
diabetes mellitus (DM) patients with and without
complications and co-morbidity in government
hospitals in Thailand. METHODS:
A cross-sectional,
prevalence based study of costs of diabetes was
done. Electronic financial databases of four
purposively selected hospitals (one teaching and
three general) were retrieved for fiscal year
2003. Diabetes patients were identified by ICD10
diagnosis code of E10 to E14 and further
classified into five categories as: 1) DM only; 2)
DM + co-morbidity (hypertension and dyslipidemia);
3) DM + microvascular (nephropathy, neuropathy,
retinopathy, foot ulcer, renal failure, blindness,
etc); 4) DM + macrovascular (coronary artery
disease, cerebro-vascular disease, and peripheral
vascular disease); and 5) DM + micro-macrovascular
complications. Both outpatient and inpatient
resource uses (lab, xrays, hospitalization, drugs
and medical supplies, etc.) were aggregated and
costs as charge were determined for each
individual. For data accuracy, diagnosis
electronic data were cross-validated with 962
patient chart review and results revealed that
microvascular complications and co-morbidity were
under-diagnosed, sometimes as much as 95%.
RESULTS:
Overall, 24,053 DM patients were
identified (1% type I), with 59 years average age
and two-thirds female. Forty percent was DM only
and 25% each with microvascular and with co-morbitity,
6%, and 4% with macrovascular and micro-macrovascular
complications respectively. Twenty-five percent of
patients had at least one hospital admission. For
average annual direct medical costs per capita, DM
only incurred $281 ($1 = 40 Thai baht), and
increased to 1.2-fold ($332), 2.1-fold ($584),
4.6-fold ($1292), and 5.7-fold ($1611), with
co-morbidity, microvascular, macrovascular and
micro-macrovascular complications respectively.
Patients with hospitalization accounted for 51% of
total costs. CONLUSIONS:
Diabetes complications
has high prevalence in Thailand and incurred
higher health resources, therefore, long-term
prevention strategies should be implemented for
better disease management and overall health care
cost reduction.
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PDB10 |
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WEIGHT GAIN IN MIDDLE AGE AND
DIABETES-RELATED MEDICAL UTILIZATION AND COSTS IN
OLDER AGE
Yan LL, Wang R, Liu K, Garside DB,
Carnethon MR, Metzger B, Daviglus ML, Northwestern
University, Chicago, IL, USA
OBJECTIVE:
To determine the relation of weight
gain in middle age with diabetes-related medical
utilization and costs in older age. METHODS:
Study
cohort included 1,063 men from the Chicago Western
Electric Study: ages 40-55, not underweight (body
mass index <18.5 kg/m2) and free of coronary heart
disease, diabetes, and cancer at baseline (1957-
8) and eligible (65+) for Medicare benefits from
1984 (the first year Medicare data were available
for research use) to 2002. Height and weight were
measured at baseline and annually thereafter until
1968. Participants were classified by average
annual weight change: weight losers (<0 lb),
moderate gainers (0-2 lbs), and heavy gainers (>2
lbs). Main outcome measures based on Medicare
claims data were diabetes-related (International
Classification of Diseases 9th revision code 250)
inpatient and outpatient diagnoses and average
annual charges (as surrogates for costs). RESULTS:
The percentage of participants with diabetes
diagnosis in older age was 20.9%, 19.0%, and 12.7%
for weight losers, moderate gainers, and heavy
gainers. After adjusting for race, education, and
baseline age and body mass index, the odds ratio
(95% confidence interval) for having a diabetes
diagnosis was 1.15 (0.77, 1.71) for moderate
gainers and 2.38 (1.44, 3.95) for heavy gainers
compared to weight losers (p value for linear
trend = 0.002). Adjusted average diabetes-related
annual charges were $400, $600, and $1000 for the
3 groups respectively (p-trend = 0.03). CONLUSIONS:
In this cohort of primarily Caucasian
men who survived to age 65 or older, weight gain
in middle age was strongly associated with
diabetes-related medical utilization and costs in
older age. Our finding adds to existing evidence
on the impact of obesity and weight gain on
diabetes and has profound implications for
Medicare expenditure given the rise in obesity and
diabetes epidemic.
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PDB11 |
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THE CORE DIABETES MODEL –
SIMULATING LONG-TERM EFFECTS OF IMPLEMENTING
HEALTH POLICIES FOR MANAGEMENT OF DIABETES
Palmer A1, Valentine WJ1, Ray JA1, Lurati
FM1, Foos V1, Minshall ME2, Roze S1, 1CORE -
Center for Outcomes Research, Binningen,
Switzerland, 2CORE - Center for Outcomes Research,
Fishers, IN, USA
OBJECTIVE:
We developed an Internet-based
simulation model to determine the long-term health
and economic outcomes associated with type 1 and
type 2 diabetes and the effects of different
treatment policies. The model performs real-time
simulations to account for insulin therapy, new
devices and delivery systems, oral hypoglycemic
medications, screening and treatment strategies
for micro- and end-stage complications and
multi-factorial interventions. METHODS:
The model
is based on a series of inter-dependent, linked submodels that simulate diabetes-related
complications (cardiovascular disease,
retinopathy, hypoglycemia, ketoacidosis,
nephropathy, neuropathy, and non-specific
mortality). Each sub-model isa Markov-based model
using time, state and diabetes type dependent
probabilities derived from published sources.
Cohorts can be defined in terms of age, gender,
baseline risk factors and pre-existing
complications. First- and 2nd-order Monte Carlo
simulation using tracker variables confers memory
within the model, and accounts for uncertainty in
multiple input parameters. Cohort definitions,
economic and clinical data in the disease
management module can be edited by the user,
allowing for the inclusion of recently available
data, country-, HMO- or provider-specific
perspectives as well as hypothetical analyses. A
program is currently collecting Thai epidemiology
and cost data for future analyses. Time horizon
can be varied from 1-year to patient lifetimes.
Clinical and economic outcomes calculated by the
model include life expectancy, quality-adjusted
life expectancy, incidence, prevalence and time to
onset of diabetes-related complications, direct
and indirect medical costs and incremental
cost-effectiveness ratios. The CORE Diabetes Model
has been peer-reviewed, thoroughly validated and
documented. It is widely used to generate health
economic outcomes for submission to
decision-makers globally. CONLUSIONS:
The CORE
Diabetes Model allows results obtained from
short-term trials to be extrapolated to long-term
outcomes. Diabetes management strategies can be
compared
in different patient populations in a variety of
clinical settings, allowing investigations
geared towards improving the quality of care for
diabetes patients.
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PDB12 |
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SYSTEMATIC REVIEW OF ECONOMIC
STUDIES ON INSULIN GLARGINE
Tang Z1, Hu Y2, 1School of Public Health,
Fudan University, Shanghai, China, 2Zhongshan
Hospital, Fudan University, Shanghai, China
OBJECTIVE:
The increasing prevalence of diabetes
(DM) in China is generating a large economic
burden for health care systems. This study aims at
reviewing cost analysis and cost-effectiveness
data on the long-acting basal insulin analogue,
insulin glargine and provides experience from
other countries concerning GLAR economic aspects.
METHODS:
A systematic literature review of GLAR
versus NPH economic studies through the public and
internal database was performed. Original papers
and conference abstracts providing cost comparison
or cost-effectiveness results were included.
RESULTS:
Ten studies (one manuscript and nine
abstracts) met the inclusion criteria. Five were
cost analysis studies comparing resource used in
one year in insulin users or patients transferred
to GLAR. Costs were not completely detailed since
most studies were reported in abstracts. Five
studies from Spain, Norway, Australia, and
Switzerland were cost-effectiveness evaluations,
based on Markov model simulation that allow to
project long term costs and effects (9 to 30
years) on short-term and long-term complications
due to DM. Three studies were performed in type-1
and two in type-2 patients. HbA1c results obtained
from short-term comparative clinical trials were
the main driver of projected differences in
long-term complications and associated costs. The
quality of model-based studies is not clear due to
the limited information from abstracts.
CONLUSIONS:
Results of short-term cost-analysis
suggest that the cost of diabetes could be
decreased with GLAR by reducing the cost of
hypoglycemia treatment and hospitalization as
compared to NPH. Results from long-term analysis
indicate that GLAR is a cost-effective alternative
to NPH in patients with type-1 and type-2 diabetes
in countries where the analyses were performed.
The economic impact of insulin glargine use in
China remains to be evaluated.
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PDB13 |
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TYPE 2 DIABETES MODELS THAT
DO NOT ACCOUNT FOR MICROVASCULAR DISEASE SCREENING
RATES AND IMPORTANT CONCOMITANT MEDICATION USE MAY
LEAD TO SUBSTAINTIAL MISREPRESENTATION OF
COST-EFFECTIVENESS OF NEW MEDICATIONS
Palmer AJ1, Valentine WJ1, Ray JA1,
Minshall ME2, Roze S1, 1CORE - Center for Outcomes
Research, Binningen, Basel, Switzerland, 2CORE -
USA, LLC, Fishers, IN, USA OBJECTIVE:
A number
of diabetes models have recently been published.
They are often used to assess the
cost-effectiveness of new interventions and to
generate health economic arguments for
reimbursement submissions. The majority of these
models do not account for rates of screening for
important diabetes-related microvascular (eye,
renal and foot) disease, nor do they consider the
rates of use of important concomitant medications
like ACE inhibitor/angiotensin-2-receptor
inhibitors, statins, or aspirin. Our aim was to
test the hypothesis that not accounting for these
important factors may substantially influence
projected long-term cost-effectiveness of new
interventions. METHODS:
A published and validated
diabetes model was used to project the long-term
cost-effectiveness of a hypothetical intervention
that lowered HbA1c by 0.4%-points, and which cost
an additional $500/patient/year, versus no
intervention. Quality-adjusted life years (QALY)
and lifetime direct medical costs were calculated
for each treatment arm, assuming: A) no screening
for- and appropriate treatment of diabetes-related
complications; and B) screening rates and
concomitant medication use as seen in a typical
type 2 diabetes population in the US. RESULTS:
If
screening rates and concomitant medication use
were not considered, the hypothetical intervention
was dominant to no intervention, with 0.214 QALYs
gained (discounted 3% annually), and discounted
lifetime direct cost savings of $165/patient. When
screening rates and concomitant medication rates
were accounted for, the intervention led to
smaller improvements in QALYs, and increased
costs, with incremental costs/QALY gained of
$34,024. CONLUSIONS:
Health economic models of
diabetes must account for the costs and clinical
effects of screening for- and appropriate
treatment of important diabetic microvascular
complications, and the costs and effects of
important concomitant medications. Failure to
account for these factors may lead to inaccurate
assessment of the cost-effectiveness of new
interventions in type 2 diabetes patients.
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PDB14 |
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PHARMACOECONOMIC EVALUTIONS
REGARDING TYPE-2 DIABETES IN ASIA-PACIFIC
Shimaya M1, Li C2, Yanagisawa S2, Kamae I2,
1Harvard University, Boston, MA, USA, 2Kobe
University, Kobe, Hyogo, Japan
OBJECTIVE:
To review and assess the literature of phamacoeconomic evaluations conducted in the
Asia-Pacific region regarding type-2 diabetes
focused on oral agents to clarify in order the
current situation of pharmacoeconomic and outcomes
research and then to identify the gaps between the
information obtained and anticipated
phamacoeconomic activities in Asia. METHODS:
We
searched the PubMed and Japanese databases to find
the articles regarding economic evaluation for
type-2 diabetes. The information obtained from the
literature was critically appraised and summarized
into key elements such as the type of economic
evaluation, randomization, and so on. RESULTS:
The
literature identified was very limited: In Japan
23 articles (2 in English, 21 in Japanese), in
Taiwan 3 (1 CEA (cost-effectiveness analysis),
2COIs (cost of illness)), in India 2 (1COI, 1
descriptive), in Bangladesh 1 CEA, in Hong Kong
1COI, and no article from Korea and Singapore.
Only the Kumamoto Study in Japan reported a
randomized control trial evaluating cost and
effectiveness of insulin therapy. Most of the
articles were review/COI articles with no evidence
on cost-effectiveness to support the claims of
health economics and outcomes research focused on
oral agents. CONLUSIONS:
Evidence on
effectiveness and cost of oral agents in
prospective studies is lacking in the Asia-Pacific
region. To overcome the gaps, we identified
actions to do: 1) to perform a modeling study by
employing the evidence on oral agents in the
English literature, and 2) to conduct a
prospective study to evaluate the oral agents, and
then combine the resulting data with those of the
Kumamoto Study. Also, we suggest that a
cost-utility analysis remains for future
investigation, particularly including the
end-stages of diabetes such as dialysis or
impaired vision.
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PDB15 |
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FACTORS ASSOCIATED WITH
HEALTHCARE COSTS AND HOSPITALIZATIONS IN PATIENTS
WITH DIABETES IN THAI PUBLIC HOSPITALS
Chaikledkaew U1, Pongchareonsuk P2,
Thavornchareonsap M2, Suksomboon N3,
Tantivipanuwong S2, 1Mahidol University, Bangkok,
Thailand, 2Mahidol University, Payathai, Bangkok,
Thailand, 3Mahidol University, Rajathevi, Bangkok,
Thailand OBJECTIVE:
To investigate
factors associated with health care cost and
hospitalization in patients with diabetes in Thai
public hospitals. METHODS:
A retrospective study
was conducted by using claims data from October 1,
2001 to September 30, 2003. Dependent variables
were total health care costs and hospitalizations.
Independent variables such as demographic factors,
health care utilization, complications, comorbidities, and payment system were used as
independent variables. Univariate and multivariate
statistical analyses were applied. RESULTS:
Patients with older age [Parameter Estimate (PE) =
0.008; p < 0.0001], male gender [PE = -0.286; p <
0.0001], type 1 diabetes [PE = -0.333; p <
0.0001], and admitted to teaching hospital [PE =
0.325; p < 0.0001] had a significant impact on an
increase in health care costs and
hospitalizations. Complications (i.e., nephropathy
[PE = 0.264; p < 0.0001]) and comorbidities (i.e.,
hypertension [PE = 0.040; p < 0.0003], coronary
artery diseases [PE = 0.141; p < 0.0001], glaucoma
[PE = 0.111; p < 0.0309], and cancer [PE = 0.071;
p < 0.0492]) were positively associated with
higher health care costs. In addition, diabetic
complications or comorbidities were associated
with hospitalizations. However, diabetic patients
with hyperlipidemia [PE = -0.119; p < 0.0001; Odds
Ratio (OR) = 0.73; p < 0.0001] had significantly
lower health care costs and hospitalizations.
Patients with longer length of stay [PE = 0.006; p
< 0.0001], more outpatient visits [PE = 0.016; p <
0.0001], and taking insulin [PE = 0.330; p <
0.0001] had a significant impact on health care
costs. Payment system (fee-for-service) [PE =
0.425; p < 0.0001] was significantly associated
with higher health care costs. CONLUSIONS:
Factors associated with health care costs and
hospitalizations may help health care providers
intervene to improve patient management and
possibly reduce health care costs. |
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