Cost of Type 2 Diabetes Patients with Chronic Kidney Disease Based on Real-World Data: An Observational Population-Based Study in Spain.

This study analyzed the prevalence, costs and economic impact of chronic kidney disease CKD in patients with T2D in a Spanish Health District using real-world data. Observational cross-sectional study in adult patients with T2D was through data extracted from the information systems of the Valencia Clínico-La Malvarrosa Health District in the year 2015. Patients were stratified with the KDIGO classification for CKD. Additionally, patients were assigned to Clinical Risk Groups (CRGs) according to multimorbidity. Direct costs of primary and specialized care, and medication were estimated. The prevalence of T2D in the database population (n = 28,345) was 10.8% (mean age (SD) = 67.8 years (13.9); 51.5% male). Up to 14.935 patients (52.6%) had data on kidney function. According to the KDIGO classification, 66.2% of the patients were at low risk of CKD, 20.6% at moderately increased risk, 7.9% at high risk, and 5.2% at very high risk. The average healthcare costs associated with these four risk groups were EUR 3437, EUR 4936, EUR 5899 and EUR 7389, respectively. The large number of T2D patients with CKD in the early stages of the disease generated a significant increase in direct healthcare costs. The economic impact could be mitigated by early and comprehensive therapeutic approaches.

[A standardized amount indicator by equivalent patient to control outpatient pharmaceutical expenditure, Spain]. / Desarrollo del indicador Población Estandarizada Equivalente para el control del gasto farmacéutico ambulatorio.

BACKGROUND: The outpatient pharmaceutical expenditure in developed countries represents a huge percentage of the total health budget, because of that, it is necessary to use tools aimed to control and guarantee an efficient use of these resources. Improving the current construction of the indicator of pharmaceutical expenditure in order to have a more adjusted tool of pharmaceutical expenditure control. METHODS: We introduce the concept of "equivalent patient" in the standardization of outpatient pharmaceutical expenditure, considering in its design several socio demographic variables in order to supersede the previous model which just considered the "Co-payment status" for adjusting the outpatient pharmaceutical expenditure. We considered variables as age, sex, co-payment status and nationality to elaborate the concept of equivalent patient. RESULTS: By applying the standardization method we obtained 160 groups of consumption with weights from 0,10 to 4,39 equivalent patients. CONCLUSIONS: We obtained a tool capable of improving the construction of Pharmaceutical Expenditure Indicators, which are essential for the design of measures aimed to stimulate the rational use of drugs. In a micro level of analysis, the new indicator is useful to establish economic incentives aimed to encourage good performance from physicians in the prescription field.

Desarrollo del indicador población estandarizada equivalente para el control del gasto farmacéutico ambulatorio / A standardized amount indicator by equivalent patient to control outpatient pharmaceutical expenditure, Spain

Fundamentos: El gasto farmacéutico representa un elevado porcentaje del gasto sanitario total en la mayoría de los países desarrollados, por lo que es importante utilizar herramientas que permitan hacer un uso eficiente. El objetivo del presente trabajo es construir un indicador de gasto farmacéutico estandarizado con el fin de disponer de una herramienta objetiva de evaluación y control del gasto más precisa que el indicador utilizado hasta el momento en la Comunitat Valenciana. Métodos: Para la construcción de este indicador se introdujo el concepto de "paciente equivalente" en la estandarización de la población, lo que permitió discriminar pacientes con perfiles de consumo diferentes. Dicha estandarización tiene en cuenta una serie de variables sociodemográficas que ofrecen una estandarización de los pacientes más ajustada que la que ofrecía el modelo utilizado hasta 2011, sustituido ahora por este nuevo indicador: el anterior indicador de importe estandarizado solo consideraba como característica diferenciadora del gasto la condición de farmacia (prestación farmaceútica sin o con aportación del 40%). Las variables consideradas en el nuevo proceso de estandarización fueron, la edad, el género, la condición de prestación farmaceútica y la cobertura internacional. Resultados: Después de aplicar el método de estandarización de la población se obtuvieron 160 grupos de pacientes con consumos diferentes a los que se les adjudicó unos pesos de 0,10 a 4,39 pacientes equivalentes. Conclusiones: El indicador obtenido permite comparar poblaciones homogéneas a través del proceso de su estandarización, lo que facilita la evaluación y control del gasto farmacéutico ambulatorio considerando los patrones de consumo de cada estructura poblacional. El indicador se puede aplicar a cualquier nivel organizativo, desde departamentos de salud a facultativos, por lo que ofrece información necesaria para el establecimiento de incentivos encaminados a promover una prescripción más eficiente(AU)

Background: The outpatient pharmaceutical expenditure in developed countries represents a huge percentage of the total health budget, because of that, it is necessary to use tools aimed to control and guarantee an efficient use of these resources. Improving the current construction of the indicator of pharmaceutical expenditure in order to have a more adjusted tool of pharmaceutical expenditure control. Methods: We introduce the concept of "equivalent patient" in the standardization of outpatient pharmaceutical expenditure, considering in its design several socio demographic variables in order to supersede the previous model which just considered the "Co-payment status" for adjusting the outpatient pharmaceutical expenditure. We considered variables as age, sex, co-payment status and nationality to elaborate the concept of equivalent patient. Results: By applying the standardization method we obtained 160 groups of consumption with weights from 0,10 to 4,39 equivalent patients. Conclusions: We obtained a tool capable of improving the construction of Pharmaceutical Expenditure Indicators, which are essential for the design of measures aimed to stimulate the rational use of drugs. In a micro level of analysis, the new indicator is useful to establish economic incentives aimed to encourage good performance from physicians in the prescription fiel(AU)