Icks A, Rosenbauer J, Haastert B, Rathmann W, Grabert M, Gandjour A, Giani G, Holl R W
Department of Biometrics and Epidemiology, German Diabetes Research Institute at Heinrich-Heine-University, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
Exp Clin Endocrinol Diabetes. 2004 Jun;112(6):302-9. doi: 10.1055/s-2004-820909.
Cost-of-illness study to evaluate diabetes-related direct costs for the care of diabetic children and adolescents in Germany from the perspective of the statutory health insurance.
For all continuously treated patients < 20 years of age from 89 pediatric departments (n = 6437, 52 % male, mean age 12.5 [SD 3.8], diabetes duration 5.2 [3.3] years), diabetes-related hospitalization, ambulatory care, insulin management, glucose self measurement, and treatment with antihypertensive drugs in 2000 were ascertained, as well as metabolic control (HbA1c). Costs per patient-year were calculated in Euros (EUR) based on year 2000 prices. Using multivariate regression, the associations between costs and age, sex, diabetes duration, and metabolic control were evaluated.
Mean total costs per patient-year were EUR 2611 (interquartile range 1665 - 2807). Blood glucose self measurement, hospitalization, and insulin accounted for 37 %, 26 %, and 21 % of the costs, respectively, followed by ambulatory care (9 %), injection equipment and glucagon sets (7 %), and treatment with antihypertensive drugs (0.1 %). The total costs were significantly increased for higher age, longer diabetes duration, and higher HbA1c (p < 0.01). The costs for hospitalization were significantly associated with pubertal age (10 - 14 years) and poor metabolic control (HbA1c SDS > 5) (p < 0.001). Based on the present estimations, the total direct costs for the care of all diabetic subjects in Germany < 20 years would be EUR 66.8 (95 % CI 65.4 - 68.1) million in 2000.
Among the direct medical costs of childhood diabetes, the highest economic burden was due to glucose self measurement, hospitalization, and insulin. The costs were considerably higher in adolescents with poor metabolic control, especially the costs for hospitalization. Outpatient education programs in pediatric diabetes care, in particular targeting children with poor metabolic control, should be encouraged, including their evaluation with respect to cost and effectiveness.
开展疾病成本研究，从法定医疗保险的角度评估德国糖尿病儿童和青少年糖尿病相关的直接护理成本。
针对来自89个儿科科室的所有年龄小于20岁的持续治疗患者（n = 6437，52%为男性，平均年龄12.5岁[标准差3.8]，糖尿病病程5.2年[3.3年]），确定2000年糖尿病相关的住院治疗、门诊护理、胰岛素管理、血糖自我监测以及降压药物治疗情况，同时确定代谢控制情况（糖化血红蛋白）。根据2000年价格以欧元计算每位患者每年的成本。使用多元回归分析评估成本与年龄、性别糖尿病病程和代谢控制之间的关联。
每位患者每年的平均总成本为2611欧元（四分位间距1665 - 2807）。血糖自我监测、住院治疗和胰岛素分别占成本的37%、26%和21%，其次是门诊护理（9%）、注射设备和胰高血糖素套装（7%）以及降压药物治疗（0.1%）。年龄较大、糖尿病病程较长和糖化血红蛋白水平较高时，总成本显著增加（p < 0.01）。住院成本与青春期年龄（10 - 14岁）和代谢控制不佳（糖化血红蛋白标准差评分> 5）显著相关（p < 0.001）。根据目前的估计，2000年德国所有年龄小于20岁的糖尿病患者的直接护理总成本将为6680万欧元（95%置信区间6540 - 6810万欧元）。
在儿童糖尿病的直接医疗成本中，最高的经济负担来自血糖自我监测、住院治疗和胰岛素。代谢控制不佳的青少年成本显著更高，尤其是住院成本。应鼓励开展儿科糖尿病护理门诊教育项目，特别是针对代谢控制不佳儿童的项目，包括对其成本效益进行评估。
