Reviriego J, Gomis R, Marañés J P, Ricart W, Hudson P, Sacristán J A
Medical Department, Lilly S.A., Madrid, Spain.
Int J Clin Pract. 2008 Jul;62(7):1026-32. doi: 10.1111/j.1742-1241.2008.01783.x. Epub 2008 May 16.
To determine the costs of severe hypoglycaemia (SH) in a population of patients with type 1 diabetes mellitus in the Spanish healthcare system and the cost-effectiveness of insulin lispro over regular insulin in preventing SH episodes.
A retrospective study of 100 patients in three Spanish health centres was performed. Resource utilisation data were collected only for interventions specifically relating to the hypoglycaemic episode. The direct medical costs determined in the analyses were: costs of hospitalisation, diagnostic tests carried out, costs of treatment administered and other associated costs such as visits to the endocrinologist and re-training in glucose control, transportation and assistance of a care-giver. In addition, indirect costs such as days of lost productivity were measured. The incidence rates of SH for insulin lispro and regular insulin were obtained from the literature. The incremental cost-effectiveness of insulin lispro over regular insulin was calculated.
The overall mean cost per episode of SH was 366 euro, comprised of 65.4% direct costs and 35.6% indirect costs. The largest cost was for hospitalisation at 183 euro per episode. The SH episodes incidence rates for 100 patients per year were 33 and 73 for insulin lispro and 48 (p < 0.05) and 117 (p < 0.01) for regular insulin, in the two clinical trials found in the literature. The additional cost to prevent one episode of SH with insulin lispro over regular insulin ranged from 277 euro to insulin lispro dominance.
Severe hypoglycaemia has a significant impact on the total cost of diabetes. The use of insulin lispro is associated with reductions in annual costs because of SH and, possibly, the overall effect may be cost neutral or cost saving when total costs are considered. The cost of SH should be included in the analysis of total socio-economic burden of diabetes.
确定西班牙医疗保健系统中1型糖尿病患者群体发生严重低血糖（SH）的成本，以及赖脯胰岛素相对于常规胰岛素在预防SH发作方面的成本效益。
对西班牙三个医疗中心的100名患者进行了一项回顾性研究。仅收集与低血糖发作具体相关的干预措施的资源利用数据。分析中确定的直接医疗成本包括：住院费用、进行的诊断测试费用、给予的治疗费用以及其他相关成本，如拜访内分泌科医生和血糖控制再培训、交通以及护理人员的协助费用。此外，还测量了诸如生产力损失天数等间接成本。从文献中获取赖脯胰岛素和常规胰岛素的SH发病率。计算了赖脯胰岛素相对于常规胰岛素的增量成本效益。
SH每次发作的总体平均成本为366欧元，其中直接成本占65.4%，间接成本占35.6%。最大的成本是每次发作183欧元的住院费用。在文献中找到的两项临床试验中，赖脯胰岛素组和常规胰岛素组每年每100名患者的SH发作发病率分别为33次和73次，以及48次（p<0.05）和117次（p<0.01）。与常规胰岛素相比，使用赖脯胰岛素预防一次SH发作的额外成本从277欧元到赖脯胰岛素占优不等。
严重低血糖对糖尿病的总成本有重大影响。使用赖脯胰岛素因SH而使年度成本降低，并且当考虑总成本时，总体效果可能是成本中性或节省成本的。SH的成本应纳入糖尿病社会经济总负担的分析中。
