Bron Morgan, Guerin Annie, Latremouille-Viau Dominick, Ionescu-Ittu Raluca, Viswanathan Prabhakar, Lopez Claudia, Wu Eric Q
Takeda Pharmaceuticals International, Inc. , Deerfield, IL , USA.
J Med Econ. 2014 Sep;17(9):646-57. doi: 10.3111/13696998.2014.925905. Epub 2014 Jun 24.
To describe the distribution of costs and to identify the drivers of high costs among adult patients with type 2 diabetes mellitus (T2DM) receiving oral hypoglycemic agents.
T2DM patients using oral hypoglycemic agents and having HbA1c test data were identified from the Truven MarketScan databases of Commercial and Medicare Supplemental insurance claims (2004-2010). All-cause and diabetes-related annual direct healthcare costs were measured and reported by cost components. The 25% most costly patients in the study sample were defined as high-cost patients. Drivers of high costs were identified in multivariate logistic regressions.
Total 1-year all-cause costs for the 4104 study patients were $55,599,311 (mean cost per patient = $13,548). Diabetes-related costs accounted for 33.8% of all-cause costs (mean cost per patient = $4583). Medical service costs accounted for the majority of all-cause and diabetes-related total costs (63.7% and 59.5%, respectively), with a minority of patients incurring >80% of these costs (23.5% and 14.7%, respectively). Within the medical claims, inpatient admission for diabetes-complications was the strongest cost driver for both all-cause (OR = 13.5, 95% CI = 8.1-23.6) and diabetes-related costs (OR = 9.7, 95% CI = 6.3-15.1), with macrovascular complications accounting for most inpatient admissions. Other cost drivers included heavier hypoglycemic agent use, diabetes complications, and chronic diseases.
The study reports a conservative estimate for the relative share of diabetes-related costs relative to total cost. The findings of this study apply mainly to T2DM patients under 65 years of age.
Among the T2DM patients receiving oral hypoglycemic agents, 23.5% of patients incurred 80% of the all-cause healthcare costs, with these costs being driven by inpatient admissions, complications of diabetes, and chronic diseases. Interventions targeting inpatient admissions and/or complications of diabetes may contribute to the decrease of the diabetes economic burden.
描述成本分布情况，并确定接受口服降糖药治疗的成年2型糖尿病（T2DM）患者中高成本的驱动因素。
从商业保险和医疗保险补充保险理赔的Truven MarketScan数据库（2004 - 2010年）中识别出使用口服降糖药且有糖化血红蛋白（HbA1c）检测数据的T2DM患者。按成本构成衡量并报告全因和糖尿病相关的年度直接医疗费用。研究样本中成本最高的25%患者被定义为高成本患者。在多因素逻辑回归中确定高成本的驱动因素。
4104名研究患者的1年全因总成本为55,599,311美元（每名患者平均成本 = 13,548美元）。糖尿病相关成本占全因成本的33.8%（每名患者平均成本 = 4583美元）。医疗服务成本占全因和糖尿病相关总成本的大部分（分别为63.7%和59.5%），少数患者产生了这些成本的80%以上（分别为23.5%和14.7%）。在医疗理赔中，糖尿病并发症的住院治疗是全因成本（比值比[OR] = 13.5，95%置信区间[CI] = 8.1 - 23.6）和糖尿病相关成本（OR = 9.7，95% CI = 6.3 - 15.1）的最强成本驱动因素，大血管并发症占大多数住院病例。其他成本驱动因素包括更多地使用降糖药、糖尿病并发症和慢性病。
该研究报告了糖尿病相关成本相对于总成本相对占比的保守估计。本研究结果主要适用于65岁以下的T2DM患者。
在接受口服降糖药治疗的T2DM患者中，23.5%的患者产生了80%的全因医疗费用，这些费用由住院治疗、糖尿病并发症和慢性病驱动。针对住院治疗和/或糖尿病并发症的干预措施可能有助于减轻糖尿病的经济负担。
