Laires Pedro Almeida, Conceição João, Araújo Francisco, Dores Jorge, Silva Catarina, Radican Larry, Nogueira Ana
a 1 Merck Sharp & Dohme, Qta. da Fonte 19, 2770-192 Paço de Arcos, Portugal.
b 2 Hospital Beatriz Ângelo, Lisbon, Portugal.
Expert Rev Pharmacoecon Outcomes Res. 2016;16(2):315-25. doi: 10.1586/14737167.2015.1084230. Epub 2015 Sep 7.
Hypoglycemia is an acute complication of diabetes that increases morbidity, mortality and disease costs. We aim to estimate healthcare resource consumption and costs associated with severe hypoglycemia using the societal perspective.
A cross-sectional, observational, nationwide, multicenter, hospital-based study was conducted in seven centers of Portuguese mainland with a 1-year enrolment period. Unit costs were extracted from official/public data sources. Patient-level data were used to quantify healthcare resource use related to emergency transportation, emergency-department care and hospitalization. Productivity loss was calculated based on the Human Capital Approach.
The study enrolled 238 Type-2 diabetic patients and the proportion of hypoglycemic episodes among all emergency events during the study period was 0.075% (95% CI: 0.067-0.083%). Mean patient age was 76 years and 57.6% were female. At time of the emergency department admission, 55% of patients were using insulin, 31.5% were being treated with secretagogues, 6.7% were on a combination of both, and 6.7% were on other oral antihyperglycemic agents. Estimated mean costs in the emergency department were: emergency transportation €33, medication €4, laboratory workup €56, other exams €72, physician and nurse time €30 and €13, respectively. Mean hospitalization cost was €1271. Indirect cost averaged €15. Overall cost per hypoglycemic episode averaged €1493 (standard deviation: €2962; range: €34-26,818). Patients treated with secretagogues had the highest rates of hospitalizations and mean costs.
We conclude that severe hypoglycemic events represent a substantial cost for society and in particular for the hospitals of the National Health Service.
低血糖是糖尿病的一种急性并发症，会增加发病率、死亡率和疾病成本。我们旨在从社会角度估算与严重低血糖相关的医疗资源消耗和成本。
在葡萄牙大陆的七个中心进行了一项横断面、观察性、全国性、多中心、基于医院的研究，入组期为1年。单位成本从官方/公共数据源中提取。患者层面的数据用于量化与紧急转运、急诊科护理和住院相关的医疗资源使用情况。生产力损失根据人力资本法计算。
该研究纳入了238例2型糖尿病患者，研究期间所有紧急事件中低血糖发作的比例为0.075%（95%置信区间：0.067 - 0.083%）。患者平均年龄为76岁，57.6%为女性。在急诊科入院时，55%的患者使用胰岛素，31.5%接受促泌剂治疗，6.7%同时使用两者，6.7%使用其他口服降糖药。急诊科的估计平均成本为：紧急转运33欧元，药物4欧元，实验室检查56欧元，其他检查72欧元，医生和护士时间分别为30欧元和13欧元。平均住院成本为1271欧元。间接成本平均为15欧元。每例低血糖发作的总成本平均为1493欧元（标准差：2962欧元；范围：34 - 26,818欧元）。接受促泌剂治疗的患者住院率和平均成本最高。
我们得出结论，严重低血糖事件给社会尤其是国家卫生服务体系的医院带来了巨大成本。
