Cost Analysis of Diabetic Ketoacidosis Treatment in Tertiary Care Hospital

OBJECTIVES: Diabetic ketoacidosis (DKA) is a serious acute metabolic complication of diabetes mellitus that can be life-threatening. There were only a small number of published DKA cost data in a Thai setting. Therefore, this study aimed to determine the unit costs of DKA treatment for future cost of illness analysis.

METHODS: This retrospective cost analysis was carried out at Rajavithi Hospital in Bangkok, Thailand, during the fiscal year 2018. The sample cases were 45 inpatients with uncontrolled diabetes, defined as a glycemic index greater than 250 mg/dL. A micro-costing approach was employed from a provider perspective, and costs were presented in 2019 US dollars ($). Direct medical costs were retrieved from the hospital database, including medical instruments, drugs, medical supplies, laboratories, nursing services, and others.

RESULTS: A total of 45 DKA inpatients were enrolled from October 1, 2017 to September 30, 2018, with a mean age of 49 years. The majority of the patients (65%) were males, and only 35% were females. The average length of stay was 5.8 days. Patient-level costs for DKA treatment include laboratory, nursing service, drug and medical supplies, and medical instruments. The total cost was US$ 45,669. Nursing services presented the highest cost at US$ 368 (SE 20.39) per patient. While a major part of the patient level- cost was laboratory cost, which approximately was US$ 18,097 (40%). The total direct medical cost was US$ 59,193, as well as the proportions of labor cost, material cost, and capital cost were US$ 11,196 (19%), US$ 47,026 (79%), and US$ 971 (2%), respectively. The average direct medical cost was US$1,096 per patient.

CONCLUSIONS: This study demonstrated the substantial economic burden of DKA treatment in a tertiary care hospital. Laboratory costs accounted for the majority of patient-level DKA treatment costs, while material costs were a major part of the total direct cost.