Unidad de Investigación en Epidemiología Clínica, Hospital de Pediatria, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, (IMSS), D.F., México.
Unidad de Investigación en Economía de la Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, (IMSS), D.F., México.
Arch Med Res. 2014 Jul;45(5):400-8. doi: 10.1016/j.arcmed.2014.05.002. Epub 2014 May 11.
Diabetes represents a high epidemiological and economic burden worldwide. The cost of diabetes care increases slowly during early years, but it accelerates once chronic complications set in. There is evidence that adequate control may delay the onset of complications. Management of diabetes falls almost exclusively into primary care services until chronic complications appear. Therefore, primary care is strategic for reducing the expedited growth of costs. The objective of this study was to identify predictors of primary care costs in patients without complications in the years following diabetes diagnosis.
Direct medical costs for primary care were determined from the perspective of public health services provider. Information was obtained from medical records of 764 patients. Microcosting and average cost techniques were combined. A generalized linear regression model was developed including characteristics of patients and facilities. Primary health care costs for different patient profiles were estimated.
The mean annual primary care cost was USD$465.1. Gender was the most important predictor followed by weight status, insulin use, respiratoty infections, glycemic control and dyslipidemia. A gap in costs was observed between genders; women make greater use of resources (42.1% on average). Such differences are reduced with obesity (18.1%), overweight (22.8%), respiratory infection (20.8%) and age >80 years (26.8%). Improving glycemic control shows increasing costs but at decreasing rates.
Modifiable factors (glycemic control, weight status and comorbidities) drive primary care costs the first 10 years. Those factors had a larger effect in costs for males than in for females.
糖尿病在全球范围内具有较高的流行病学和经济负担。糖尿病治疗费用在早期增长缓慢，但一旦出现慢性并发症，其增长速度就会加快。有证据表明，适当的控制可以延缓并发症的发生。在出现慢性并发症之前，糖尿病的管理几乎完全由初级保健服务承担。因此，初级保健对于降低成本的快速增长具有战略意义。本研究的目的是确定诊断糖尿病后无并发症患者的初级保健成本的预测因素。
从公共卫生服务提供者的角度确定初级保健的直接医疗成本。信息来自 764 名患者的病历。采用微观成本法和平均成本法相结合的方法。开发了一个包含患者和设施特征的广义线性回归模型。估计了不同患者特征的初级保健成本。
初级保健的年平均费用为 465.1 美元。性别是最重要的预测因素，其次是体重状况、胰岛素使用、呼吸道感染、血糖控制和血脂异常。在性别之间观察到成本差距；女性使用资源的比例更高（平均为 42.1%）。这些差异随着肥胖（18.1%）、超重（22.8%）、呼吸道感染（20.8%）和年龄>80 岁（26.8%）而减少。血糖控制的改善会导致成本增加，但增加的速度会降低。
可改变的因素（血糖控制、体重状况和合并症）在最初的 10 年推动了初级保健成本的增加。这些因素对男性的成本影响大于对女性的成本影响。
