Yang W C, Hwang S J, Chiang S S, Chen H F, Tsai S T
Division of Nephrology, Department of Medicine, School of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, No. 201, Shih-Pai Road, Section 2, Taipei 11217, Taiwan, ROC.
Diabetes Res Clin Pract. 2001 Nov;54 Suppl 1:S47-54. doi: 10.1016/s0168-8227(01)00309-6.
Diabetes mellitus carries a great burden on healthcare costs due to its growing population and high co-morbidity. This adverse effect sustains even when patients develop end-stage renal disease (ESRD). We here present data showing the effect of diabetes on economic costs in dialysis therapy in Taiwan. As of the end of 1997, we have 22,027 ESRD patients with a prevalence and incidence rate of 1013 and 253 per million populations, respectively. Diabetic nephropathy is the second most common cause of the underlying renal diseases, but accounts for 24.8% of the prevalent patients and 35.9% of the incident cases. The diabetic patients engendered 11.8% more expense for care of dialysis than the non-diabetic patients (US $26,988 vs. US $24,146 per patient-year). Higher inpatient cost mainly account for the difference. As compared to non-diabetic patients, the diabetic patients had 3.5 times more inpatients costs (US $1325 vs. US $4677 per patient-year), and higher proportion of inpatient-to-annualized cost ratio (5.5 vs. 17.3%) resulting from their more frequent hospitalization (0.59 vs. 1.13 times per patient-year) and longer hospital stay (6.7 vs. 18.9 days per patient-year). The major causes responsible for a more frequent hospitalization were cardiovascular disease, poorly controlled hyperglycemia, sepsis and failure of vascular access. The annualized costs for care of dialysis patients in Taiwan, including inpatient and outpatient costs, averaged US $25,576 per patient-year. This value is approximately half of that in most of the western countries and Japan. Thus, a more cost-effective way to achieve savings is to reduce the high incidence rate of dialysis population and to maximize the quality of dialysis treatment for avoiding hospitalization. Recent studies had shown that tight blood pressure control, intensive glycemic control, and use of angiotensin converting enzyme inhibitors in diabetic patients significantly reduced not only the rate of progressive renal failure, but also substantially reduced the cost of complications and led to higher cost effectiveness. Once diabetic patients reach stage of ESRD, an optimized pre-ESRD care and consideration of kidney transplantation are essential in terms of better patient survival and cost savings.
由于糖尿病患者人数不断增加且合并症高发，糖尿病给医疗成本带来了巨大负担。即便患者发展到终末期肾病（ESRD），这种负面影响依然存在。我们在此展示的数据表明了糖尿病对台湾透析治疗经济成本的影响。截至1997年底，我们有22,027例ESRD患者，患病率和发病率分别为每百万人口1013例和253例。糖尿病肾病是潜在肾脏疾病的第二大常见病因，但占患病患者的24.8%，占新发病例的35.9%。糖尿病患者的透析护理费用比非糖尿病患者高出11.8%（每位患者每年26,988美元对24,146美元）。较高的住院费用是造成这种差异的主要原因。与非糖尿病患者相比，糖尿病患者的住院费用高出3.5倍（每位患者每年1325美元对4677美元），且住院费用占年度费用的比例更高（5.5%对17.3%），这是由于他们住院更频繁（每位患者每年0.59次对1.13次）且住院时间更长（每位患者每年6.7天对18.9天）。导致住院更频繁的主要原因是心血管疾病、血糖控制不佳、败血症和血管通路故障。台湾透析患者的年度护理费用，包括住院和门诊费用，平均每位患者每年25,576美元。这个数值大约是大多数西方国家和日本的一半。因此，实现节约成本的更具成本效益的方法是降低透析人群的高发病率，并最大限度提高透析治疗质量以避免住院。最近的研究表明，糖尿病患者严格控制血压、强化血糖控制以及使用血管紧张素转换酶抑制剂不仅能显著降低进行性肾衰竭的发生率，还能大幅降低并发症成本并提高成本效益。一旦糖尿病患者达到ESRD阶段，优化ESRD前护理并考虑肾脏移植对于提高患者生存率和节约成本至关重要。
