Chadee A, Blackhouse G, Goeree R
Ont Health Technol Assess Ser. 2014 Jul 1;14(9):1-23. eCollection 2014.
The increasing prevalence of diabetes in Ontario means that there will be growing demand for hemoglobin A1c (HbA1c) testing to monitor glycemic control as part of managing this chronic disease. Testing HbA1c where patients receive their diabetes care may improve system efficiency if the results from point-of-care HbA1c testing are comparable to those from laboratory HbA1c measurements.
To estimate the budget impact of point-of-care HbA1c testing to replace laboratory HbA1c measurement for monitoring glycemic control in patients with diabetes in 2013/2014.
This analysis compared the average testing cost of 3 point-of-care HbA1c devices licensed by Health Canada and available on the market in Canada (Bayer's A1cNow+, Siemens's DCA Vantage, and Bio Rad's In2it), with that of the laboratory HbA1c reference method. The cost difference between point-of-care HbA1c testing and laboratory HbA1c measurement was calculated. Costs and the corresponding range of net impact were estimated in sensitivity analyses.
The total annual costs of laboratory HbA1c measurement and point-of-care HbA1c testing for 2013/2014 were $91.5 million and $86.8 million, respectively. Replacing all laboratory HbA1c measurements with point-of-care HbA1c testing would save approximately $4.7 million over the next year. Savings could be realized by the health care system at each level that point-of-care HbA1c testing is substituted for laboratory HbA1c measurement. If physician fees were excluded from the analysis, the health care system would incur a net impact from using point-of-care HbA1c testing instead of laboratory A1c measurement.
Point-of-care HbA1c technology is already in use in the Ontario health care system, but the current uptake is unclear. Knowing the adoption rate and market share of point-of-care HbA1c technology would allow for a more accurate estimate of budget impact.
Replacing laboratory HbA1c measurement with point-of-care HbA1c testing or using point-of-care HbA1c testing in combination with laboratory HbA1c measurement to monitor glycemic control in patients with diabetes could have saved the province $1,175,620 to $4,702,481 in 2013/2014.
安大略省糖尿病患病率不断上升，这意味着作为管理这种慢性病的一部分，对糖化血红蛋白（HbA1c）检测以监测血糖控制的需求将不断增加。如果即时检测糖化血红蛋白（HbA1c）的结果与实验室糖化血红蛋白（HbA1c）测量结果具有可比性，那么在患者接受糖尿病护理的地方进行HbA1c检测可能会提高系统效率。
评估2013/2014年即时检测糖化血红蛋白（HbA1c）以取代实验室糖化血红蛋白（HbA1c）测量来监测糖尿病患者血糖控制的预算影响。
本分析比较了加拿大卫生部批准并在加拿大市场上有售的3种即时检测糖化血红蛋白（HbA1c）设备（拜耳的A1cNow +、西门子的DCA Vantage和伯乐的In2it）的平均检测成本与实验室糖化血红蛋白（HbA1c）参考方法的成本。计算了即时检测糖化血红蛋白（HbA1c）与实验室糖化血红蛋白（HbA1c）测量之间的成本差异。在敏感性分析中估计了成本和相应的净影响范围。
2013/2014年实验室糖化血红蛋白（HbA1c）测量和即时检测糖化血红蛋白（HbA1c）的年度总成本分别为9150万美元和8680万美元。用即时检测糖化血红蛋白（HbA1c）取代所有实验室糖化血红蛋白（HbA1c）测量在明年可节省约470万美元。在即时检测糖化血红蛋白（HbA1c）取代实验室糖化血红蛋白（HbA1c）测量的每个医疗保健层面都可实现节省。如果分析中不包括医生费用，医疗保健系统使用即时检测糖化血红蛋白（HbA1c）而非实验室糖化血红蛋白（HbA1c）测量将产生净影响。
即时检测糖化血红蛋白（HbA1c）技术已在安大略省医疗保健系统中使用，但目前的采用情况尚不清楚。了解即时检测糖化血红蛋白（HbA1c）技术的采用率和市场份额将有助于更准确地估计预算影响。
用即时检测糖化血红蛋白（HbA1c）取代实验室糖化血红蛋白（HbA1c）测量或结合使用即时检测糖化血红蛋白（HbA1c）和实验室糖化血红蛋白（HbA1c）测量来监测糖尿病患者的血糖控制，在2013/2014年可为该省节省1175620美元至4702481美元。
