EPHE Sorbonne, Systèmes intégrés, environnement et biodiversité, (SIEB), Paris, France.
BMC Endocr Disord. 2013 Apr 29;13:15. doi: 10.1186/1472-6823-13-15.
This study compares annual ambulatory care expenditures per patient with type 2 diabetes mellitus (T2DM) in France according to treatment phase and renal function status.
Records from patients with T2DM were extracted from a health insurance database. Patients were classified in subgroups, by treatment phase: oral/GLP1 monotherapy, double therapy, triple therapy or insulin therapy, and according to renal function status (identified using pharmacy, lab and consultation claims). Annual ambulatory expenditures were estimated from the national insurance perspective by year (from 2005 to 2010) and subgroup.
The number of patients ranged from 9,682 to 11,772 between 2005 and 2010. The average annual expenditure per individual in 2010 ranged from €3,017 (standard deviation: €3,829) for monotherapy to €3,609 ± €3,801 for triple therapy, and €7,398 ± €5,487 with insulin (adjusted ratio insulin therapy/monotherapy: 2.36, p < 0.001). Similar differences between treatement stages were found in previous years. Additional costs for insulin were mainly related to nursing care (multiplied by 18.42, p < 0.001), medical devices and pharmacy costs. DM-attributable drug costs were mainly related to antidiabetic drugs (28% for monotherapy to 71% for triple therapy), but also to cardiovascular system drugs (21% for monotherapy to 51% with insulin) and nervous system drugs (up to 8% with insulin). Declining renal function was associated with an increase in expenses by 12% to 53% according to treatment stage.
Overall, ambulatory care expenditures increase with treatment escalation and declining renal function amongst patients with T2DM. Insulin therapy is associated with substantially increased costs, related to pharmacy, nursing care and medical device costs.
本研究比较了法国不同治疗阶段和肾功能状态的 2 型糖尿病（T2DM）患者的年度门诊医疗支出。
从健康保险数据库中提取 T2DM 患者的记录。根据治疗阶段将患者分为亚组：口服/GLP1 单药治疗、双药治疗、三药治疗或胰岛素治疗，根据肾功能状态（通过药房、实验室和咨询记录确定）进行分组。从国家保险的角度，按年度（2005 年至 2010 年）和亚组估算年度门诊支出。
2005 年至 2010 年期间，患者人数在 9682 至 11772 之间。2010 年，单人平均年支出从单药治疗的 3017 欧元（标准差：3829 欧元）到三药治疗的 3609 欧元±3801 欧元，胰岛素治疗为 7398 欧元±5487 欧元（胰岛素治疗与单药治疗的调整比值：2.36，p<0.001）。前几年也发现了治疗阶段之间的类似差异。胰岛素的额外费用主要与护理（乘以 18.42，p<0.001）、医疗设备和药房费用有关。糖尿病相关药物费用主要与降糖药物有关（单药治疗为 28%，三药治疗为 71%），但也与心血管系统药物（单药治疗为 21%，胰岛素治疗为 51%）和神经系统药物（高达胰岛素治疗的 8%）有关。根据治疗阶段，肾功能下降与费用增加 12%至 53%相关。
总体而言，T2DM 患者的门诊医疗支出随治疗升级和肾功能下降而增加。胰岛素治疗与药房、护理和医疗设备费用相关的费用大幅增加。
