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Costs and outcomes of "intermediate" vs "minimal" care for youth-onset type 1 diabetes in six countries.
Gregory, Gabriel A; Guo, Jingchuan; Klatman, Emma L; Ahmadov, Gunduz A; Besançon, Stéphane; Gomez, Elizabeth D; Fawwad, Asher; Ramaiya, Kaushik; Wijesuriya, Mahen A; Orchard, Trevor J; Ogle, Graham D.
Afiliación
  • Gregory GA; Life for a Child Program, Diabetes NSW, Glebe, New South Wales, Australia.
  • Guo J; Sydney Medical School, University of Sydney, Sydney, Australia.
  • Klatman EL; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • Ahmadov GA; Life for a Child Program, Diabetes NSW, Glebe, New South Wales, Australia.
  • Besançon S; The Endocrine Center, Baku, Azerbaijan.
  • Gomez ED; Azerbaijan Medical University, Baku, Azerbaijan.
  • Fawwad A; ONG Santé Diabète Délégation Mali, Bamako, Mali.
  • Ramaiya K; Centro Vivir con Diabetes, Cochabamba, Bolivia.
  • Wijesuriya MA; Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.
  • Orchard TJ; Shree Hindu Mandal Hospital, Dar Es Salaam, Tanzania.
  • Ogle GD; Diabetes Association of Sri Lanka, National Diabetes Centre, Colombo, Sri Lanka.
Pediatr Diabetes ; 21(4): 628-636, 2020 06.
Article en En | MEDLINE | ID: mdl-31970828
ABSTRACT

OBJECTIVE:

Data are needed to demonstrate that providing an "intermediate" level of type 1 diabetes (T1D) care is cost-effective compared to "minimal" care in less-resourced countries. We studied these care scenarios in six countries.

METHODS:

We modeled the complications/costs/mortality/healthy life years (HLYs) associated with "intermediate" care including two blood glucose tests/day (mean HbA1c 9.0% [75 mmol/mol]) in three lower-gross domestic product (GDP) countries (Mali, Tanzania, Pakistan), or three tests/day (mean HbA1c 8.5% [69 mmol/mol]) in three higher-GDP countries (Bolivia, Sri Lanka, Azerbaijan); and compared findings to "minimal" care (mean HbA1c 12.5% [113 mmol/mol]). A discrete time Markov illness-death model with age and calendar-year-dependent transition probabilities was developed, with inputs of 30 years of complications and Standardized Mortality Rate data from the youth cohort in the Pittsburgh Epidemiology of Diabetes Complications Study, background mortality, and costs determined from international and local prices.

RESULTS:

Cumulative 30 years incidences of complications were much lower for "intermediate care" than "minimal care", for example, for renal failure incidence was 68.1% (HbA1c 12.5%) compared to 3.9% (9%) and 2.4% (8.5%). For Mali, Tanzania, Pakistan, Bolivia, Sri Lanka, and Azerbaijan, 30 years survival was 50.1%/52.7%/76.7%/72.5%/82.8%/89.2% for "intermediate" and 8.5%/10.1%/39.4%/25.8%/45.5%/62.1% for "minimal" care, respectively. The cost of a HLY gained as a % GDP/capita was 141.1%/110.0%/52.3%/41.8%/17.0%/15.6%, respectively.

CONCLUSIONS:

Marked reductions in complications rates and mortality are achievable with "intermediate" T1D care achieving mean clinic HbA1c of 8.5% to 9% (69-75 mmol/mol). This is also "very cost-effective" in four of six countries according to the WHO "Fair Choices" approach which costs HLYs gained against GDP/capita.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Atención a la Salud / Diabetes Mellitus Tipo 1 Tipo de estudio: Health_economic_evaluation / Prognostic_studies País/Región como asunto: Africa / America do sul / Asia / Bolivia / Europa Idioma: En Revista: Pediatr Diabetes Asunto de la revista: ENDOCRINOLOGIA Año: 2020 Tipo del documento: Article País de afiliación: Australia

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Atención a la Salud / Diabetes Mellitus Tipo 1 Tipo de estudio: Health_economic_evaluation / Prognostic_studies País/Región como asunto: Africa / America do sul / Asia / Bolivia / Europa Idioma: En Revista: Pediatr Diabetes Asunto de la revista: ENDOCRINOLOGIA Año: 2020 Tipo del documento: Article País de afiliación: Australia