Unit of Metabolic Diseases and Clinical Dietetics, Alma Mater Studiorum University, Bologna, Italy.
Nutr Metab Cardiovasc Dis. 2011 May;21(5):339-46. doi: 10.1016/j.numecd.2009.10.009. Epub 2010 Feb 13.
AIMS/HYPOTHESIS: To estimate the prevalence and the direct cost of pharmacologically-treated diabetes in Italy.
The ARNO observatory database, containing the 20-year medical prescriptions of over 10 million Italian people, was used. Ten-year longitudinal data were available in 22 Local Health Districts (LHD). Subjects were classified as having diabetes when prescribed glucose-lowering drugs (oral agents or insulin) (311,979 individuals in 2006). The direct cost was calculated as the sum of drug use, financial compensation by LHD for the inpatient (hospital DRG) and outpatient activities (consultations, laboratory tests, radiology, etc.), all regulated by government contracts. Individuals with diabetes were compared with pharmacologically-treated subjects without diabetes, pair-matched for age, sex and general practitioner.
In the 10-year period, the prevalence of pharmacologically-treated diabetes increased from 3.08% to 4.45% (P for trend, <0.001). The average pro capita cost totaled €2,589 in 2006 (95% confidence interval (CI), 2,584-2,594), corresponding to a rate ratio vs. no-diabetes of 1.54 (95% CI, 1.50-1.56). The cost of drugs was € 827 (rate ratio, 1.80 vs. no-diabetes; 95% CI, 1.79-1.82), that of service use, € 488 (rate ratio, 1.07 (0.93-1.25). Only 20% of the pharmaceutical cost was due to glucose-lowering drugs, a percentage stable through the years. The cost of any hospital admission, as defined by DRGs, was independent of diabetes, but the overall cost was much higher in diabetes due to much higher admission rates. Cardiovascular complications and renal failure accounted for the large majority of excess hospital cost.
The direct economic burden of pharmacologically-treated diabetes on the National Health System is very high, due to the growing prevalence of disease and the cost of complications.
目的/假设：估计意大利经药物治疗的糖尿病的患病率和直接成本。
使用了 ARNO 观察站数据库，该数据库包含了超过 1000 万意大利人的 20 年医疗处方。在 22 个地方卫生区（LHD）可获得 10 年的纵向数据。当开具降血糖药物（口服药物或胰岛素）时，将受试者分类为患有糖尿病（2006 年有 311979 人）。直接成本计算为药物使用、LHD 对住院（医院 DRG）和门诊活动（咨询、实验室检查、放射学等）的费用补偿之和，所有这些都受政府合同的监管。将患有糖尿病的个体与未经药物治疗的、年龄、性别和全科医生匹配的糖尿病患者进行比较。
在 10 年期间，经药物治疗的糖尿病的患病率从 3.08%增加到 4.45%（趋势 P<0.001）。2006 年人均平均总成本为 2589 欧元（95%置信区间（CI），2584-2594），与无糖尿病相比的比率为 1.54（95%CI，1.50-1.56）。药物成本为 827 欧元（比率，1.80 与无糖尿病；95%CI，1.79-1.82），服务使用成本为 488 欧元（比率，1.07（0.93-1.25））。药物成本仅占药品成本的 20%，这一比例多年来保持稳定。任何住院治疗的费用（按 DRG 定义）与糖尿病无关，但由于住院率较高，糖尿病的总费用要高得多。心血管并发症和肾衰竭占额外住院费用的绝大部分。
由于疾病的患病率不断增加和并发症的成本，国家卫生系统中经药物治疗的糖尿病的直接经济负担非常高。
