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1.
Value Health ; 24(2): 227-235, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33518029

RESUMEN

OBJECTIVES: This study aims to estimate the national impact and cost-effectiveness of the 2018 American College of Physicians (ACP) guidance statements compared to the status quo. METHODS: Survey data from the 2011-2016 National Health and Nutrition Examination were used to generate a national representative sample of individuals with diagnosed type 2 diabetes in the United States. Individuals with A1c <6.5% on antidiabetic medications are recommended to deintensify their A1c level to 7.0% to 8.0% (group 1); individuals with A1c 6.5% to 8.0% and a life expectancy of <10 years are recommended to deintensify their A1c level >8.0% (group 2); and individuals with A1c >8.0% and a life expectancy of >10 years are recommended to intensify their A1c level to 7.0% to 8.0% (group 3). We used a Markov-based simulation model to evaluate the lifetime cost-effectiveness of following the ACP recommended A1c level. RESULTS: 14.41 million (58.1%) persons with diagnosed type 2 diabetes would be affected by the new guidance statements. Treatment deintensification would lead to a saving of $363 600 per quality-adjusted life-year (QALY) lost for group 1 and a saving of $118 300 per QALY lost for group 2. Intensifying treatment for group 3 would lead to an additional cost of $44 600 per QALY gain. Nationally, the implementation of the guidance would add 3.2 million life-years and 1.1 million QALYs and reduce healthcare costs by $47.7 billion compared to the status quo. CONCLUSIONS: Implementing the new ACP guidance statements would affect a large number of persons with type 2 diabetes nationally. The new guidance is cost-effective.


Asunto(s)
Diabetes Mellitus Tipo 2/sangre , Sociedades Médicas/normas , Adulto , Anciano , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/economía , Hemoglobina A Glucada , Guías como Asunto , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Humanos , Hipoglucemiantes/economía , Hipoglucemiantes/uso terapéutico , Esperanza de Vida , Persona de Mediana Edad , Modelos Económicos , Estados Unidos
2.
Value Health ; 24(2): 274-280, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33518034

RESUMEN

OBJECTIVES: Health utility decrement estimates for diabetes and complications are needed for parametrization of simulation models that aim to assess the cost-utility of diabetes prevention and care strategies. This study estimates health utility decrements associated with diabetes and cardiovascular and microvascular complications from a population-based German study. METHODS: Data were obtained from the population based cross-sectional KORA (Cooperative Health Research in the Augsburg Region) health questionnaire 2016 and comprised n = 1072 individuals with type 2 diabetes and n = 7879 individuals without diabetes. Health utility was assessed through the EQ-5D-5L. We used linear regression models with interaction terms between type 2 diabetes and different cardiovascular and microvascular complications while adjusting for demographic and socio-economic factors and other comorbidities. RESULTS: Type 2 diabetes (ß = -0.028, standard error [SE] = 0.014), stroke (ß = -0.070, SE = 0.010), cardiac arrhythmia (ß = -0.031, SE = 0.006), heart failure (ß = -0.073, SE = 0.009), coronary heart disease (ß = -0.028, SE = 0.010), myocardial infarction (ß = -0.020, SE = 0.011, estimates of main effect), and neuropathy (ß = -0.067, SE = 0.020), diabetic foot (ß = -0.042, SE = 0.030), nephropathy (ß = -0.032, SE = 0.025), and blindness (ß = -0.094, SE = 0.056, estimates of interaction terms) were negatively associated with health utility. The interaction term for diabetes x stroke (ß = -0.052, SE = 0.021) showed that the utility decrement for stroke is significantly larger in people with type 2 diabetes than in people without diabetes. CONCLUSIONS: Diabetes, cardiovascular, and microvascular conditions are associated with significant health utility decrements. Utility decrements for some conditions differ between people with and without type 2 diabetes. These results are of high relevance for the parametrization of decision analytic simulation models and applied health economic evaluations in the field of prevention and management of type 2 diabetes in Germany.


Asunto(s)
Análisis Costo-Beneficio/métodos , Diabetes Mellitus Tipo 2/economía , Angiopatías Diabéticas/economía , Cardiomiopatías Diabéticas/economía , Factores de Edad , Anciano , Anciano de 80 o más Años , Pesos y Medidas Corporales , Comorbilidad , Estudios Transversales , Diabetes Mellitus Tipo 2/prevención & control , Femenino , Alemania , Conductas Relacionadas con la Salud , Promoción de la Salud/economía , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Factores Socioeconómicos
3.
Lancet Diabetes Endocrinol ; 9(4): 203-211, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33636102

RESUMEN

BACKGROUND: Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of clinically diagnosed diabetes has changed over time. METHODS: In this multicountry data analysis, we assembled aggregated data describing trends in diagnosed total or type 2 diabetes incidence from 24 population-based data sources in 21 countries or jurisdictions. Data were from administrative sources, health insurance records, registries, and a health survey. We modelled incidence rates with Poisson regression, using age and calendar time (1995-2018) as variables, describing the effects with restricted cubic splines with six knots for age and calendar time. FINDINGS: Our data included about 22 million diabetes diagnoses from 5 billion person-years of follow-up. Data were from 19 high-income and two middle-income countries or jurisdictions. 23 data sources had data from 2010 onwards, among which 19 had a downward or stable trend, with an annual estimated change in incidence ranging from -1·1% to -10·8%. Among the four data sources with an increasing trend from 2010 onwards, the annual estimated change ranged from 0·9% to 5·6%. The findings were robust to sensitivity analyses excluding data sources in which the data quality was lower and were consistent in analyses stratified by different diabetes definitions. INTERPRETATION: The incidence of diagnosed diabetes is stabilising or declining in many high-income countries. The reasons for the declines in the incidence of diagnosed diabetes warrant further investigation with appropriate data sources. FUNDING: US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.


Asunto(s)
Agregación de Datos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/economía , Salud Global/tendencias , Renta/tendencias , Internacionalidad , Diabetes Mellitus Tipo 2/epidemiología , Humanos , Incidencia
5.
Expert Rev Pharmacoecon Outcomes Res ; 21(2): 221-233, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33317348

RESUMEN

Introduction: As a novel glucagon-like peptide-1receptor agonist (GLP-1 RA) for type 2 diabetes (T2D) treatment, the economic value of once-weekly semaglutide had been assessed in several country settings. The authors' objective was to systematically review the existing pharmacoeconomic literature evaluating the cost-effectiveness associated with once-weekly semaglutide compared with other GLP-1 RAs and provide implications for further researches.Areas covered: We conducted a systematic literature review of cost-effectiveness analysis (CEA) published up to 25 July 2020 in PubMed, web of science, and the ISPOR presentation database, compared once-weekly semaglutide with other GLP-1 RAs in T2D. Nineteen studies were identified, including 8 short-term and 11 long-term studies. General characteristics and main results of the included studies were summarized.Expert opinion: This review provided references for other countries to overview the value of once-weekly semaglutide compared with other GLP-1 RAs in T2D in the healthcare decision-making process and to conduct their CEA studies associated with once-weekly semaglutide. The authors found that the cardiovascular (CV) benefit of once-weekly semaglutide was under-estimated in current studies and suggested that the methods of economic evaluations for novel anti-diabetic drugs with CV benefit should be improved in future researches.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Péptidos Similares al Glucagón/administración & dosificación , Hipoglucemiantes/administración & dosificación , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/economía , Esquema de Medicación , Economía Farmacéutica , Receptor del Péptido 1 Similar al Glucagón/agonistas , Péptidos Similares al Glucagón/economía , Péptidos Similares al Glucagón/farmacología , Humanos , Hipoglucemiantes/economía , Hipoglucemiantes/farmacología
6.
Artículo en Inglés | MEDLINE | ID: mdl-32784771

RESUMEN

Diabetes causes significant disabilities, reduced quality of life and mortality that imposes huge economic burden on societies and governments worldwide. Malaysia suffers a high diabetes burden in Asia, but the magnitude of healthcare expenditures documented to aid national health policy decision-making is limited. This systematic review aimed to document the economic burden of diabetes in Malaysia, and identify the factors associated with cost burden and the methods used to evaluate costs. Studies conducted between 2000 and 2019 were retrieved using three international databases (PubMed, Scopus, EMBASE) and one local database (MyCite), as well as manual searches. Peer reviewed research articles in English and Malay on economic evaluations of adult type 2 diabetes conducted in Malaysia were included. The review was registered with PROSPERO (CRD42020151857), reported according to PRISMA and used a quality checklist adapted for cost of illness studies. Data were extracted using a data extraction sheet that included study characteristics, total costs, different costing methods and a scoring system to assess the quality of studies reviewed. The review identified twelve eligible studies that conducted cost evaluations of type 2 diabetes in Malaysia. Variation exists in the costs and methods used in these studies. For direct costs, four studies evaluated costs related to complications and drugs, and two studies were related to outpatient and inpatient costs each. Indirect and intangible costs were estimated in one study. Four studies estimated capital and recurrent costs. The estimated total annual cost of diabetes in Malaysia was approximately USD 600 million. Age, type of hospitals or health provider, length of inpatient stay and frequency of outpatient visits were significantly associated with costs. The most frequent epidemiological approach employed was prevalence-based (n = 10), while cost analysis was the most common costing approach used. The current review offers the first documented evidence on cost estimates of diabetes in Malaysia.


Asunto(s)
Costo de Enfermedad , Diabetes Mellitus Tipo 2/economía , Costos de la Atención en Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Adulto , Complicaciones de la Diabetes/economía , Diabetes Mellitus Tipo 2/psicología , Humanos , Malasia , Calidad de Vida , Perfil de Impacto de Enfermedad
7.
Diabetes Res Clin Pract ; 167: 108336, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32755762

RESUMEN

OBJECTIVE: In 2007, the Ministry of Health (MoH) in Mexico implemented a multidisciplinary health-care model (MHC) for patients with type-2 diabetes (T2D), which has proven more effective in controlling this condition than the conventional health-care model (CHC). RESEARCH DESIGN AND METHODS: We compared the cost-effectiveness of the MHC vs. the CHC for patients with T2D using a quasi-experimental, retrospective design. Epidemiologic and cost data were obtained from a randomly selected sample of health-care units, using medical records as well as patient- and facility-level data. We modelled the cost-effectiveness of the MHC at one, 10 and 20 years using a simulation model. RESULTS: The average cumulative costs per patient at 20 years were US$4,225 for the MHC and US$4,399 for the CHC. With a willingness to pay one gross domestic product (GDP) per capita per quality-adjusted life year (QALY) (US$8,910), the incremental net benefits per patient were US$1,450 and US$3,737 at 10 and 20 years, respectively. The MHC was cost-effective from the third year onward; however, increasing coverage to 500 patients per year rendered it cost-effective at year one. CONCLUSIONS: The MHC is cost-effective at 10 and 20 years. Cost-effectiveness can be achieved in the short term by increasing MHC coverage.


Asunto(s)
Prestación de Atención de Salud/economía , Diabetes Mellitus Tipo 2/epidemiología , Sector Público , Adulto , Anciano , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/economía , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Modelos Teóricos , Años de Vida Ajustados por Calidad de Vida , Estudios Retrospectivos
8.
Cardiovasc Diabetol ; 19(1): 95, 2020 06 22.
Artículo en Inglés | MEDLINE | ID: mdl-32571319

RESUMEN

BACKGROUND: Dapagliflozin is one of the novel glucose-lowering agents, which has recently been reported to reduce the risk of hospitalization for heart failure (hHF). The present study aimed to compare the differences between the risk of hHF after using dapagliflozin and dipeptidyl peptidase-4 inhibitors (DPP-4i) as second-line drugs for the treatment of type 2 diabetes mellitus using the latest nationwide population data in Korea. Additionally, we aimed to examine the impact of clinical outcomes on direct medical costs in the two groups. METHODS: The present population-based, retrospective cohort study was conducted using the nationwide claims data between September 01, 2014 and June 30, 2018. New users of dapagliflozin and DPP-4i were identified from the database and the differences in patients' characteristics between the two groups were analyzed using propensity score-weighted analysis. Cox proportional hazards regression analysis was used to estimate the risk of hHF. A simple model was used for the estimation of direct medical costs for 3 years. RESULTS: In total, 23,147 patients in the dapagliflozin group and 237,187 patients in the DPP-4i group were selected for the analysis. The incidence rates of hHF were 3.86 and 6.79 per 1000 person-years in the dapagliflozin and DPP-4i groups, respectively. In the entire study population, the hazard ratio for hHF in the dapagliflozin group compared to the DPP-4i group was 0.58 (95% confidence interval 0.46-0.74), with 0.55 (95% confidence interval 0.41-0.74) among patients with underlying cardiovascular disease and 0.66 (95% confidence interval 0.46-0.95) among patients without underlying cardiovascular disease. The direct medical costs were $57,787 lower in the dapagliflozin group than in the DPP-4i group for 3 years. CONCLUSIONS: This study showed that dapagliflozin lowers the risk for hHF and subsequently reduces direct medical costs compared to DPP-4i. The protective effect against hHF was more evident among patients with underlying cardiovascular disease.


Asunto(s)
Compuestos de Bencidrilo/economía , Compuestos de Bencidrilo/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/economía , Inhibidores de la Dipeptidil-Peptidasa IV/economía , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Costos de los Medicamentos , Glucósidos/economía , Glucósidos/uso terapéutico , Insuficiencia Cardíaca/economía , Insuficiencia Cardíaca/prevención & control , Inhibidores del Cotransportador de Sodio-Glucosa 2/economía , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Adulto , Anciano , Compuestos de Bencidrilo/efectos adversos , Ahorro de Costo , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Inhibidores de la Dipeptidil-Peptidasa IV/efectos adversos , Femenino , Glucósidos/efectos adversos , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Costos de Hospital , Humanos , Incidencia , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
9.
PLoS One ; 15(6): e0234324, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32511267

RESUMEN

OBJECTIVE: Low individual socioeconomic status (SES) is known to be associated with a higher risk of type 2 diabetes mellitus (T2DM), but the extent to which the local context in which people live may influence T2DM rates remains unclear. This study examines whether living in a low property value neighbourhood is associated with higher rates of T2DM independently of individual SES. RESEARCH DESIGN AND METHODS: Using cross-sectional data from the Maastricht Study (2010-2013) and geographical data from Statistics Netherlands, multilevel logistic regression was used to assess the association between neighbourhood property value and T2DM. Individual SES was based on education, occupation and income. Of the 2,056 participants (aged 40-75 years), 494 (24%) were diagnosed with T2DM. RESULTS: Individual SES was strongly associated with T2DM, but a significant proportion of the variance in T2DM was found at the neighbourhood level (VPC = 9.2%; 95% CI = 5.0%-16%). Participants living in the poorest neighbourhoods had a 2.38 times higher odds ratio of T2DM compared to those living in the richest areas (95% CI = 1.58-3.58), independently of individual SES. CONCLUSIONS: Neighbourhood property value showed a significant association with T2DM, suggesting the usefulness of area-based programmes aimed at improving neighbourhood characteristics in order to tackle inequalities in T2DM.


Asunto(s)
Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/epidemiología , Vivienda/economía , Características de la Residencia , Adulto , Anciano , Estudios Transversales , Femenino , Vivienda/estadística & datos numéricos , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Pobreza/economía , Pobreza/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Clase Social
10.
Medicine (Baltimore) ; 99(26): e20800, 2020 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-32590763

RESUMEN

Medication adherence plays an important role in disease management, especially for diabetes. The aim of this study was to examine the impacts of demographic characteristics on medication nonadherence and the impacts of nonadherence on both health status and medical expenses for diabetic patients in Taiwan.A total of 1 million diabetes mellitus patients were randomly selected from the National Health Insurance Research Database between January 1, 2000 and December 31, 2004. All records with missing values and those for participants under 18 years of age were then deleted. Because many patients had multiple clinical visit records, all records within the same calendar year were summarized into 1 single record for each person. This pre-processing resulted in 14,602 total patients with a combined 73,010 records over the course of 5 years. Generalized estimating equation models were then constructed to investigate the effects of demographic characteristics on medication nonadherence and the effects of nonadherence on patient health status and medical expenses. The demographic characteristics examined for each patient include gender, age, residential area, and socioeconomic status.Our analysis of how demographic variables impacted nonadherence revealed that elderly patients exhibited better overall medication adherence, but that male patients exhibited poorer medication adherence than female patients. Next, our analysis of how nonadherence impacted health status revealed that patients who exhibited medication nonadherence had poorer health status than patients with proper medication adherence. Finally, our analysis of how nonadherence impacted medical expenses revealed that patients who exhibited medication nonadherence incurred more medical expenses than those who exhibited proper medication adherence.This study's empirical results corroborate the general relationships expressed in the current literature regarding medication nonadherence. However, this study's results were statistically more reliable and revealed the precise impact on health status in terms of the Charlson comorbidity index and increased annual medical expenses. This indicates the need to improve patient attitudes toward medication adherence, which can have substantial effects both medically and economically.


Asunto(s)
Diabetes Mellitus Tipo 2 , Disparidades en el Estado de Salud , Hipoglucemiantes/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Gastos en Salud/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/estadística & datos numéricos , Evaluación de Necesidades , Taiwán/epidemiología
11.
West Afr J Med ; 37(3): 237-247, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32476117

RESUMEN

BACKGROUND: Type 2 diabetes mellitus can be a major drain on resources due to lifelong treatment and risk of catastrophic expenditure from treatment of complications. The prevalence has been projected to rise to alarming levels in developing countries. This study aimed to assess the levels of, and associations between good glycaemic control among patients with type 2 diabetes and their modes of financing healthcare. METHODS: In this hospital based descriptive cross-sectional study, 260 patients being managed for type 2 diabetes at the outpatient clinics of Lagos University Teaching Hospital, Lagos were recruited by systematic random sampling method. All participants received a HBA1C test to assess glycaemic control and a composite interviewer administered questionnaire adapted from the MMAS-8 and diabetes care profile to assess medication adherence, modes of financing and other factors related to disease management. RESULTS: Of the 260 study participants, 34.62% (90) had good glycaemic control. In the mode of health care financing only 15% (39) paid by health insurance (NHIS), while 85% of the respondents' payment was by out-of-pocket (OOP) payment. About half of these OOP payments were made by family, friends and others (in this study, a proxy for informal means of pooling finances). Significant associations were found between glycaemic control and adherence (2 13.93, p=0.001), glycaemic control and mode of payment (2 15.30, p=0.0000) and also adherence and mode of payment (2 16.59, p =0.002). CONCLUSION: In this study, only about a third of patients with type 2 diabetes achieved good glycaemic control, most patients used OOP financing and patients with OOP financing had poorer adherence and poorer glycaemic control. There is a need to scale up health insurance to improve health outcomes in diabetes management and protect people in developing countries from the burden of health care costs of chronic diseases like type 2 diabetes.


Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Financiación Personal/economía , Gastos en Salud/estadística & datos numéricos , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación , Adulto , Estudios Transversales , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/economía , Femenino , Financiación Personal/estadística & datos numéricos , Hemoglobina A Glucada/análisis , Hospitales de Enseñanza , Humanos , Hipoglucemiantes/economía , Insulina/economía , Masculino , Persona de Mediana Edad , Nigeria , Factores Socioeconómicos
12.
PLoS One ; 15(5): e0232250, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32401778

RESUMEN

AIMS: Type 2 diabetes mellitus (T2DM) and gestational diabetes (GDM) are globally on the rise, accompanied by comorbidities and associated health costs. Increased physical activity, healthy nutrition, and weight loss have shown the potential to prevent T2DM/GDM. Despite this, reaching vulnerable groups remains a key challenge. The aim of this scoping review was to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups. METHODS: We conducted a systematic literature search in May 2018, updated in September 2019, in several databases (e.g. PubMed, Embase) to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups. Two reviewers independently screened the results. Extracted data was charted, categorized, and summarized. RESULTS: We included 125 articles. Ninety-eight studies were extracted, and eight categories of barriers and facilitating factors were formed. The most common categories of barriers were limited knowledge, family/friends, and economic factors, and the most common categories of facilitating factors were family/friends, social support, and knowledge. CONCLUSION: This scoping review identified various barriers and facilitating factors in vulnerable groups. Preventive interventions should consider these barriers and facilitating factors in developing preventive interventions or in adapting existing ones.


Asunto(s)
Diabetes Mellitus Tipo 2/prevención & control , Diabetes Gestacional/prevención & control , Prevención Primaria/métodos , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/psicología , Diabetes Gestacional/economía , Diabetes Gestacional/psicología , Femenino , Humanos , Embarazo , Prevención Primaria/economía , Prevención Primaria/estadística & datos numéricos
13.
JAMA Netw Open ; 3(5): e206603, 2020 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-32453386

RESUMEN

Importance: Electronic health record (EHR) systems and disease management programs (DMP) are often promoted, but associated health care cost changes are not well understood. Objective: To evaluate the association between annual health care costs of patients with type 2 diabetes and the use of an electronic health record system with a disease management program (EHR/DMP) in general practice. Design, Setting, and Participants: This retrospective cohort study examined patients with type 2 diabetes in Denmark between January 1, 2008, and December 31, 2014, who attended practices that either used an EHR/DMP at a high level or never used the disease management system. An EHR/DMP system was rolled out across general practices in Denmark beginning in 2011 and was discontinued in 2014. Data were analyzed between March 2019 and March 2020. Main Outcomes and Measures: The main outcome was total health care costs, and the secondary outcomes were primary care, medication, nonhospital specialist, and hospital (total, outpatient, inpatient, and emergency) costs. Regression models were used to estimate EHR/DMP-associated percentage differences in patients' annual health care treatment costs across health care treatment categories. All models included general practice-level fixed effects and patient-level controls. Two-part models examined robustness of estimated associations for hospital cost categories. Results: Of 33 970 patients included in the analysis, 15 953 (8016 [50.2%] male; mean [SD] age, 59.9 [13.3] years) attended 244 general practices that used the system at a high level, and 18 017 (9291 [51.6%] male; mean [SD] age, 60.0 [12.9] years) attended 344 general practices that had never used the system. Use of the EHR/DMP was associated with 3.2% higher (95% CI, 0.9%-5.6%) annual general practice treatment costs and with 6.4% lower (95% CI, -11.6% to -1.2%) annual hospital emergency visit costs. The associations between EHR/DMP use and annual total hospital (percentage difference, -0.8%; 95% CI, -7.5% to 5.7%) and total health care (percentage difference, -0.1%; 95% CI, -2.1% to 1.9%) cost changes were not statistically significant. Conclusions and Relevance: Among patients with type 2 diabetes, attendance at general practices that used an EHR/DMP was associated with a moderate increase in primary care costs and a reduction in emergency hospital visit costs but no significant change in total health care costs. Large health care cost savings associated with improved use of EHR-based disease management systems should not be expected to be realized in the short term.


Asunto(s)
Diabetes Mellitus Tipo 2/economía , Manejo de la Enfermedad , Registros Electrónicos de Salud , Costos de la Atención en Salud/estadística & datos numéricos , Dinamarca , Diabetes Mellitus Tipo 2/terapia , Registros Electrónicos de Salud/economía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mejoramiento de la Calidad/economía , Mejoramiento de la Calidad/organización & administración
14.
Value Health ; 23(4): 434-440, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32327160

RESUMEN

OBJECTIVES: Outcomes-based contracts tie rebates and discounts for expensive drugs to outcomes. The objective was to estimate the utility of outcomes-based contracts for diabetes medications using real-world data and to identify methodologic limitations of this approach. METHODS: A population-based cohort study of adults newly prescribed a medication for diabetes with a publicly announced outcomes-based contract (ie, exenatide microspheres ["exenatide"], dulaglutide, or sitagliptin) was conducted. The comparison group included patients receiving canagliflozin or glipizide. The primary outcome was announced in the outcomes-based contract: the percentage of adults with a follow-up hemoglobin A1C <8% up to 1 year later. Secondary outcomes included the percentage of patients diagnosed with hypoglycemia and the cost of a 1-month supply. RESULTS: Thousands of adults newly filled prescriptions for exenatide (n = 5079), dulaglutide (n = 6966), sitagliptin (n = 40 752), canagliflozin (n = 16 404), or glipizide (n = 59 985). The percentage of adults subsequently achieving a hemoglobin A1C below 8% ranged from 83% (dulaglutide, sitagliptin) to 71% (canagliflozin). The rate of hypoglycemia was 25 per 1000 person-years for exenatide, 37 per 1000 person-years for dulaglutide, 28 per 1000 person-years for sitagliptin, 18 per 1000 person-years for canagliflozin, and 34 per 1000 person-years for glipizide. The cash price for a 1-month supply was $847 for exenatide, $859 for dulaglutide, $550 for sitagliptin, $608 for canagliflozin, and $14 for glipizide. CONCLUSION: Outcomes-based pricing of diabetes medications has the potential to lower the cost of medications, but using outcomes such as hemoglobin A1C may not be clinically meaningful because similar changes in A1C can be achieved with generic medications at a far lower cost.


Asunto(s)
Contratos/economía , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Evaluación de Resultado en la Atención de Salud/métodos , Anciano , Canagliflozina/administración & dosificación , Canagliflozina/economía , Estudios de Cohortes , Diabetes Mellitus Tipo 2/economía , Exenatida/administración & dosificación , Exenatida/economía , Femenino , Estudios de Seguimiento , Glipizida/administración & dosificación , Glipizida/economía , Péptidos Similares al Glucagón/administración & dosificación , Péptidos Similares al Glucagón/análogos & derivados , Péptidos Similares al Glucagón/economía , Humanos , Hipoglucemiantes/economía , Fragmentos Fc de Inmunoglobulinas/administración & dosificación , Fragmentos Fc de Inmunoglobulinas/economía , Masculino , Persona de Mediana Edad , Proteínas Recombinantes de Fusión/administración & dosificación , Proteínas Recombinantes de Fusión/economía , Fosfato de Sitagliptina/administración & dosificación , Fosfato de Sitagliptina/economía
15.
Medicine (Baltimore) ; 99(14): e19613, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32243386

RESUMEN

The economic burden of diabetes has increased over time with disease severity. Previous publications investigating the effects of physical activity (PA) on medical costs have made use of small sample sizes. We assessed the relationship between PA and 1-year medical expenditure among Taiwanese patients with type-2 diabetes mellitus (T2DM).Data were recruited from three governmental databases, including the 2012 adult preventive health service database. Participants were grouped as inactive (no exercise), insufficiently active (exercise < 150 minutes/week), and sufficiently active (exercise >150 minutes/week) individuals. Patients were stratified according to age and Charlson score. Multivariate linear regression models were used to determine ß-coefficients and their P values.Overall, 218,960 individuals were identified with diabetes. The prevalence of the disease was 13.1% among sufficiently active, 35% among insufficiently active, and 51.9% among physically inactive adults. In general, patients who had exercise >150 minutes/week had lower health care spending (i.e., US$ 755.83) followed by those who had less than 150 minutes/week (US$ 880.08) when compared with inactive patients (P < .0001). Moreover, health care costs derived from outpatient or inpatient care were lower for sufficiently active than inactive participants (P < .0001).Compared with being sedentary, PA was associated with lower health care costs of Taiwanese adults with diabetes mellitus.


Asunto(s)
Costo de Enfermedad , Diabetes Mellitus Tipo 2/economía , Ejercicio Físico , Gastos en Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Anciano , Bases de Datos Factuales , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Hospitalización/economía , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Conducta Sedentaria , Índice de Severidad de la Enfermedad , Taiwán/epidemiología
16.
Acta Diabetol ; 57(9): 1049-1056, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32248347

RESUMEN

AIMS: The past 3 decades witnessed the rapid growth of diabetes in China. To better serve large numbers of patients, the Chinese Medical Doctor Association launched metabolic management center (MMC) program which is featured with a one-stop and comprehensive diabetes management mode in 2016. It is worth exploring whether MMC model is better than conventional models in management. METHODS: In this study, 228 patients with type 2 diabetes were recruited, and 193 patients completed the study. Therapeutic effects and health care costs were analyzed. RESULTS AND CONCLUSIONS: Our results showed that decreases in HbA1C and TG/HDL-C values were significantly greater in the MMC group than in the control group. The increase in HDL-C was significantly higher in the MMC group than in the control group. The percentage of patients whose HbA1C lower than 7% was significantly higher in the MMC group. The results of the UKPDS model simulation showed that within 30 years, with the slight increases in treatment costs, the average life expectancy and total QALE of the MMC group are higher than those of the control group by 0.61 and 0.51 year, respectively. Further study showed that the drug intervention in the MMC group was significantly stronger. In addition, the questionnaires revealed that MMC group performed better in diabetes knowledge tests and have higher patient satisfaction rates of medical services. More patients in the MMC group adopted a more favorable diet strategy. These advantages enable MMC to achieve more short-term and long-term benefits in diabetes treatment than conventional mode.


Asunto(s)
Atención Integral de Salud , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/terapia , Automanejo , Nivel de Atención , China/epidemiología , Atención Integral de Salud/métodos , Atención Integral de Salud/organización & administración , Atención Integral de Salud/normas , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/economía , Educación del Paciente como Asunto/organización & administración , Educación del Paciente como Asunto/normas , Satisfacción del Paciente , Evaluación de Programas y Proyectos de Salud , Automanejo/economía , Automanejo/métodos , Automanejo/psicología , Nivel de Atención/economía , Nivel de Atención/organización & administración , Nivel de Atención/normas , Encuestas y Cuestionarios
17.
Curr Diab Rep ; 20(4): 12, 2020 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-32166504

RESUMEN

PURPOSE OF REVIEW: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recently approved class of drugs (since 2012) for type 2 diabetes mellitus (T2DM), but their economic merits have yet been fully confirmed. The objective of this review was to evaluate the most updated evidence that examined the cost-effectiveness of SGLT2i for T2DM. RECENT FINDINGS: We systematically searched Medline (PubMed), EMBASE, and Web of Science for eligible articles from January 1, 2011, to October 31, 2019, using combinations of search words. A supplementary search using reference lists of eligible articles and other review articles was also performed. A multistage screening process was carried out with duplicates removal, abstract screening, and full-text reading to confirm eligibility. Two reviewers independently screened the eligible articles and assessed reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. A total of 24 studies were included in the final review. All studies showed good quality according to the CHEERS checklist (scored 21-24). Seven studies compared SGLT2i vs. dipeptidyl peptidase-4 inhibitors (DPP-4i), 3 studies compared SGLT2i vs. sulfonylureas (SU), 3 compared SGLT2i vs. glucagon-like peptide-1 receptor agonist (GLP-1 RA), 2 compared SGLT2i vs. SGLT2i, 3 compared SGLT2i vs. other antidiabetic therapies including thiazolidinediones (TZD), alpha-glucosidase inhibitors (AGI) or insulin, and 5 compared SGLT2i vs. standard care/metformin. Most studies concluded SGLT2i was cost-effective relative to its comparator except GLP-1 RA, where two studies suggested GLP-1 RA was the favorable treatment option relative to SGLT2i. The literature demonstrated that SGLT2i may be cost-effective compared to many antidiabetic therapies including DPP-4i, SU, TZD, AGI, insulin, and standard care .


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/economía , Humanos , Inhibidores del Cotransportador de Sodio-Glucosa 2/economía
19.
Diabetes Res Clin Pract ; 161: 108073, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32061637

RESUMEN

AIMS: The objective of this systematic review is to identify and assess the quality of published decision-analytic models evaluating the long-term cost-effectiveness of target-driven intensive interventions for single and multifactorial risk factor control compared to standard care in people with type 2 diabetes. METHODS: We searched the electronic databases MEDLINE, the National Health Service Economic Evaluation Database, Web of Science and the Cochrane Library from inception to October 31, 2019. Articles were eligible for inclusion if the studies had used a decision-analytic model evaluating both the long-term costs and benefits associated with intensive interventions for risk factor control compared to standard care in people with type 2 diabetes. Data were extracted using a standardised form, while quality was assessed using the decision-analytic model-specific Philips-criteria. RESULTS: Overall, nine articles (11 models) were identified, four models evaluated intensive glycaemic control, three evaluated intensive blood pressure control, two evaluated intensive lipid control, and two evaluated intensive multifactorial interventions. Six reported using discrete-time simulations modelling approach, whereas five reported using a Markov modelling framework. The majority, seven studies, reported that the intensive interventions were dominant or cost-effective, given the assumptions and analytical perspective taken. The methodological and reporting quality of the studies was generally weak, with only four studies fulfilling more than 50% of their applicable Philips-criteria. CONCLUSIONS: This is the first systematic review of decision-analytic models of target-driven intensive interventions for single and multifactorial risk factor control in individuals with type 2 diabetes. Identified shortcomings are lack of transparency in data identification and evidence synthesis as well as for the selection of the modelling approaches. Future models should aim to include greater evaluation of the quality of the data sources used and the assessment of uncertainty in the model.


Asunto(s)
Análisis Costo-Beneficio/métodos , Diabetes Mellitus Tipo 2/economía , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Factores de Riesgo , Adulto Joven
20.
Diabetes Res Clin Pract ; 162: 108084, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32061819

RESUMEN

The prevalence of type 2 diabetes mellitus continues to rise and simultaneously technology has contributed to the growth of MHealth interventions for its prevention, monitoring and management. This systematic review aimed to summarize and evaluate the quality of the published evidence on cost and cost-effectiveness of mHealth interventions for T2DM. A systematic literature search of PubMed, EMBASE, and Web of Science was conducted for papers up to end of April 2019. We included all partial or full economic evaluations providing cost or cost-effectiveness results for mHealth interventions targeting individuals diagnosed with, or at risk of, type 2 diabetes mellitus. Twenty-three studies met the inclusion criteria. Intervention cost varied substantially based on the type and numbers or combination of technologies used, ranging from 1.8 INT $ to 10101.1 INT $ per patient per year. The studies which presented cost effectiveness results demonstrated highly cost-effective interventions, with cost per QALY gained ranging from 0.4 to 62.5 percent of GDP per capita of the country. The quality of partial economic evaluations was on average lower than that of full economic evaluations. Cost of mHealth interventions varied substantially based on type and combination of technology used, however, where cost-effectiveness results were reported, the intervention was cost-effective. PROSPERO registration number: CRD42019123476; Registered: 27/01/2019.


Asunto(s)
Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/prevención & control , Telemedicina/economía , Telemedicina/estadística & datos numéricos , Humanos
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