PDF(Pubmed)
Abstract：
BACKGROUND: This study aims to define the distribution of direct healthcare costs for people with diabetes treated in two healthcare regions in Italy, based on number of comorbidities and treatment regimen.
METHODS: This was a retrospective analysis using data from two local health authority administrative databases (Campania and Umbria) in Italy for the years 2014-2018. Data on hospital care, pharmaceutical and specialist outpatient and laboratory assistance were collected. All people with diabetes in 2014-2018 were identified on the basis of at least one prescription of hypoglycemic drugs (ATC A10), hospitalization with primary or secondary diagnosis of diabetes mellitus (ICD9CM 250.xx) or diabetes exemption code (code 013). Subjects were stratified into three groups according to their pharmaceutical prescriptions during the year: Type 1/type 2 diabetes (T1D/T2D) treated with multiple daily injections with insulin (MDI), type 2 diabetes on basal insulin only (T2D-Basal) and type 2 diabetes not on insulin therapy (T2D-Oral).
RESULTS: We identified 304,779 people with diabetes during the period for which data was obtained. Analysis was undertaken on 288,097 subjects treated with glucose-lowering drugs (13% T1D/T2D-MDI, 13% T2D-Basal, 74% T2D-Oral). Average annual cost per patient for the year 2018 across the total cohort was similar for people with T1D/T2D-MDI and people with T2D-Basal (respectively €2580 and €2254) and significantly lower for T2D-Oral (€1145). Cost of hospitalization was the main driver (47% for T1D/T2D-MDI, 45% for T2D-Basal, 45% for T2D-Oral) followed by drugs/devices (35%, 39%, 43%) and outpatient services (18%, 16%, 12%). Average costs increased considerably with increasing comorbidities: from €459 with diabetes only to €7464 for a patient with four comorbidities. Similar trends were found across all subgroups analysis.
CONCLUSIONS: Annual cost of treatment for people with diabetes is similar for those treated with MDI or with basal insulin only, with hospitalization being the main cost driver. This indicates that both patient groups should benefit from having access to scanning continuous glucose monitoring (CGM) technology which is known to be associated with significantly reduced hospitalization for acute diabetes events, compared to self-monitored blood glucose (SMBG) testing.
METHODS: This was a retrospective analysis using data from two local health authority administrative databases (Campania and Umbria) in Italy for the years 2014-2018. Data on hospital care, pharmaceutical and specialist outpatient and laboratory assistance were collected. All people with diabetes in 2014-2018 were identified on the basis of at least one prescription of hypoglycemic drugs (ATC A10), hospitalization with primary or secondary diagnosis of diabetes mellitus (ICD9CM 250.xx) or diabetes exemption code (code 013). Subjects were stratified into three groups according to their pharmaceutical prescriptions during the year: Type 1/type 2 diabetes (T1D/T2D) treated with multiple daily injections with insulin (MDI), type 2 diabetes on basal insulin only (T2D-Basal) and type 2 diabetes not on insulin therapy (T2D-Oral).
RESULTS: We identified 304,779 people with diabetes during the period for which data was obtained. Analysis was undertaken on 288,097 subjects treated with glucose-lowering drugs (13% T1D/T2D-MDI, 13% T2D-Basal, 74% T2D-Oral). Average annual cost per patient for the year 2018 across the total cohort was similar for people with T1D/T2D-MDI and people with T2D-Basal (respectively €2580 and €2254) and significantly lower for T2D-Oral (€1145). Cost of hospitalization was the main driver (47% for T1D/T2D-MDI, 45% for T2D-Basal, 45% for T2D-Oral) followed by drugs/devices (35%, 39%, 43%) and outpatient services (18%, 16%, 12%). Average costs increased considerably with increasing comorbidities: from €459 with diabetes only to €7464 for a patient with four comorbidities. Similar trends were found across all subgroups analysis.
CONCLUSIONS: Annual cost of treatment for people with diabetes is similar for those treated with MDI or with basal insulin only, with hospitalization being the main cost driver. This indicates that both patient groups should benefit from having access to scanning continuous glucose monitoring (CGM) technology which is known to be associated with significantly reduced hospitalization for acute diabetes events, compared to self-monitored blood glucose (SMBG) testing.
摘要：
背景：这项研究旨在确定在意大利两个医疗保健地区接受治疗的糖尿病患者的直接医疗保健费用的分布，根据合并症的数量和治疗方案。
方法：这是一项回顾性分析，使用了2014-2018年意大利两个地方卫生当局行政数据库（坎帕尼亚和翁布里亚）的数据。医院护理数据，收集了药物和专科门诊和实验室援助。2014-2018年的所有糖尿病患者都是根据至少一种降糖药（ATCA10）处方确定的，主要或次要诊断为糖尿病的住院治疗(ICD9CM250。xx)或糖尿病豁免代码(代码013)。根据一年中的药物处方将受试者分为三组：1型/2型糖尿病（T1D/T2D），每天多次注射胰岛素（MDI），仅使用基础胰岛素的2型糖尿病（T2D-Basal）和不使用胰岛素治疗的2型糖尿病（T2D-Oral）。
结果：在获得数据期间，我们确定了304,779名糖尿病患者。对288,097名接受降糖药物治疗的受试者进行了分析（13％T1D/T2D-MDI，13%T2D-基础，74%T2D-口服)。T1D/T2D-MDI患者和T2D-Basal患者2018年的平均年费用相似（分别为2580欧元和2254欧元），T2D-Oral患者的平均年费用显着降低（1145欧元）。住院费用是主要驱动因素(T1D/T2D-MDI占47%，T2D-Basal的45%，T2D-口服占45%），其次是药物/器械（35%，39%,43%)和门诊服务(18%，16%,12%）。随着合并症的增加，平均费用大大增加：从糖尿病患者的459欧元增加到患有四种合并症的患者的7464欧元。在所有亚组分析中发现了类似的趋势。
结论：糖尿病患者的年治疗费用与仅接受MDI或基础胰岛素治疗的患者相似。住院是主要的费用驱动因素。这表明，两组患者都应受益于扫描连续血糖监测（CGM）技术，该技术已知与急性糖尿病事件的住院率显着减少有关。与自我监测血糖（SMBG）测试相比。
方法：这是一项回顾性分析，使用了2014-2018年意大利两个地方卫生当局行政数据库（坎帕尼亚和翁布里亚）的数据。医院护理数据，收集了药物和专科门诊和实验室援助。2014-2018年的所有糖尿病患者都是根据至少一种降糖药（ATCA10）处方确定的，主要或次要诊断为糖尿病的住院治疗(ICD9CM250。xx)或糖尿病豁免代码(代码013)。根据一年中的药物处方将受试者分为三组：1型/2型糖尿病（T1D/T2D），每天多次注射胰岛素（MDI），仅使用基础胰岛素的2型糖尿病（T2D-Basal）和不使用胰岛素治疗的2型糖尿病（T2D-Oral）。
结果：在获得数据期间，我们确定了304,779名糖尿病患者。对288,097名接受降糖药物治疗的受试者进行了分析（13％T1D/T2D-MDI，13%T2D-基础，74%T2D-口服)。T1D/T2D-MDI患者和T2D-Basal患者2018年的平均年费用相似（分别为2580欧元和2254欧元），T2D-Oral患者的平均年费用显着降低（1145欧元）。住院费用是主要驱动因素(T1D/T2D-MDI占47%，T2D-Basal的45%，T2D-口服占45%），其次是药物/器械（35%，39%,43%)和门诊服务(18%，16%,12%）。随着合并症的增加，平均费用大大增加：从糖尿病患者的459欧元增加到患有四种合并症的患者的7464欧元。在所有亚组分析中发现了类似的趋势。
结论：糖尿病患者的年治疗费用与仅接受MDI或基础胰岛素治疗的患者相似。住院是主要的费用驱动因素。这表明，两组患者都应受益于扫描连续血糖监测（CGM）技术，该技术已知与急性糖尿病事件的住院率显着减少有关。与自我监测血糖（SMBG）测试相比。
