Chevalier P, Vandebrouck T, De Keyzer D, Mertens A, Lamotte M
a a IMS Health HEOR , Vilvoorde , Belgium.
b b Novo Nordisk , Brussels , Belgium.
J Med Econ. 2016;19(1):44-52. doi: 10.3111/13696998.2015.1086775. Epub 2015 Oct 1.
Little is known about the economic burden of hypoglycemia in Belgium, or its related co-morbidities. This study aimed at estimating the cost and length of stay associated with hypoglycemia-related hospitalizations in diabetic patients in Belgium and the association between hypoglycemia and in-hospital all-cause mortality, incidence of traumatic fractures, depression, and cardiovascular diseases (myocardial infarction or unstable angina), using retrospective data from 2011.
Patient data were retrieved from the IMS Hospital Disease Database, including longitudinal (per calendar year) information on diagnoses, procedures, and drugs prescribed in ∼20% of all Belgian hospital beds. The eligible population included all adult (<19 year) diabetic (both types) patients, further split between those with/without a history of hypoglycemia-related hospitalizations. Diabetes, hypoglycemia, and co-morbidities of interest were identified based on International Classification of Diseases and Related Health Problems Version 9 (ICD-9) diagnosis codes. All costs were extrapolated to 2014 using progression in hospitalization costs since 2001.
A total of 43,410 diabetes-related hospitalizations were retrieved, corresponding to 30,710 distinct patients. The average hospitalization cost was €10,258 when hypoglycemia was documented (n = 2625), vs €7173 in other diabetic hospitalized patients (n = 40,785). When controlling for age and sex, a higher mortality risk (OR = 1.59; p-value <0.001), a higher incidence of traumatic fractures (OR = 1.25; p-value = 0.009), and a higher probability of depression-related hospitalizations (OR = 1.90; p-value <0.001) were observed in hypoglycemic patients. A similar risk of cardiovascular event was observed in both groups, but hypoglycemic patients were more at risk of experiencing multiple events.
Hospitalizations for hypoglycemia are expensive and associated with an increased risk of depression and traumatic fractures as well as increased in-hospital mortality. Interventions that can help reduce the risk of hypoglycemia, and consequently the burden on hospitals and society, without compromising glycemic control, will help to further improve diabetes management.
关于比利时低血糖的经济负担及其相关合并症，人们了解甚少。本研究旨在利用2011年的回顾性数据，估算比利时糖尿病患者低血糖相关住院的费用和住院时间，以及低血糖与院内全因死亡率、创伤性骨折发生率、抑郁症和心血管疾病（心肌梗死或不稳定型心绞痛）之间的关联。
从IMS医院疾病数据库中检索患者数据，其中包括约占比利时所有医院床位20%的机构（按日历年）的诊断、治疗程序和所开药物的纵向信息。符合条件的人群包括所有成年（<19岁）糖尿病（两种类型）患者，进一步分为有/无低血糖相关住院史的患者。根据《国际疾病分类及相关健康问题》第9版（ICD - 9）诊断代码确定糖尿病、低血糖及相关合并症。所有费用根据2001年以来住院费用的增长情况推算至2014年。
共检索到43410例与糖尿病相关的住院病例，对应30710名不同患者。有低血糖记录的患者（n = 2625）平均住院费用为10258欧元，而其他糖尿病住院患者（n = 40785）为7173欧元。在控制年龄和性别后，低血糖患者的死亡风险更高（OR = 1.59；p值<0.001），创伤性骨折发生率更高（OR = 1.25；p值 = 0.009），与抑郁症相关的住院概率更高（OR = 1.90；p值<0.001）。两组心血管事件风险相似，但低血糖患者发生多种事件的风险更高。
低血糖相关住院费用高昂，且与抑郁症、创伤性骨折风险增加以及院内死亡率上升相关联。在不影响血糖控制的情况下，有助于降低低血糖风险从而减轻医院和社会负担的干预措施，将有助于进一步改善糖尿病管理。
