Centro de Endocrinología Experimental y Aplicada, PAHO/WHO Collaborating Centre for Diabetes, La Plata, Argentina.
Value Health. 2011 Jul-Aug;14(5 Suppl 1):S20-3. doi: 10.1016/j.jval.2011.05.018.
To estimate the cost-consequence of interventions to prevent hospitalizations for heart failure (HF) in people with type 2 diabetes.
In HF events (63) from type 2 diabetes-related hospitalizations (N = 462) recorded in an Argentine hospital (March 2004-April 2005), we verified 1) the presence of one metabolic HF predictor (glycosylated hemoglobin [HbA1c] value) before hospitalization; and 2) in a simulation model, the resources needed for its prevention controlling such predictor during 6 months before and after the event. Sensitivity analysis of HF risk reduction, hospitalization cost, and cost of different treatments to achieve HbA1c 7% or less was performed with a Monte Carlo simulation (10,000 iterations).
HF represented 14% of hospitalizations, with a 44% rehospitalization rate for the same cause. Due to the total estimated cost for an HF hospitalization event was $437.31, the prevention attained using our simulated treatment was $2326.51. The number needed to treat to prevent an HF event under any of the proposed alternatives to reduce HbA1c would be 3.57 (95% confidence interval 2.00-16.67). The additional cost of the simulated treatment versus the real one oscillates between $6423.91 and $8455.68.
HbA1c control to reduce the number of HF events would be economically beneficial for health care payers.
评估预防 2 型糖尿病患者心力衰竭（HF）住院的干预措施的成本效益。
在阿根廷一家医院（2004 年 3 月至 2005 年 4 月）记录的与 2 型糖尿病相关的住院 HF 事件（63 例）中（N=462），我们验证了 1）住院前是否存在一个代谢性 HF 预测指标（糖化血红蛋白[HbA1c]值）；2）在模拟模型中，在事件发生前和后 6 个月内，预防该预测指标所需的资源。通过蒙特卡罗模拟（10000 次迭代）对 HF 风险降低、住院费用以及实现 HbA1c＜7%的不同治疗方案的成本进行了敏感性分析。
HF 占住院的 14%，同一病因的再住院率为 44%。由于 HF 住院事件的总估计费用为 437.31 美元，因此我们模拟治疗的预防费用为 2326.51 美元。在任何 HbA1c 降低替代方案下，预防 HF 事件的治疗人数需要为 3.57（95%置信区间 2.00-16.67）。模拟治疗与实际治疗相比，额外费用在 6423.91 美元至 8455.68 美元之间波动。
控制 HbA1c 以减少 HF 事件的数量将对医疗保健支付方具有经济效益。
