Liu Jieruo, Wang Rosa, Ganz Michael L, Paprocki Yurek, Schneider Doron, Weatherall James
a Evidera , Waltham , MA , USA.
b Novo Nordisk Inc. , Plainsboro , NJ , USA.
Curr Med Res Opin. 2018 Jan;34(1):171-177. doi: 10.1080/03007995.2017.1391079. Epub 2017 Nov 10.
Approximately 1.25 million people in the US have type 1 diabetes mellitus (T1DM), a chronic metabolic disease that develops from the body's inability to produce insulin, and requires life-long insulin therapy. Poor insulin adherence may cause severe hypoglycemia (SHO), leading to hospitalization and long-term complications; these, in turn, drive up costs of SHO and T1DM overall. This study's objective was to estimate the prevalence and costs of SHO-related hospitalizations and their additional longer-term impacts on patients with T1DM using basal-bolus insulin.
Using Truven MarketScan claims, we identified adult T1DM patients using basal-bolus insulin regimens who were hospitalized for SHO (inpatient SHO patients) during 2010-2015. Two comparison groups were defined: those with outpatient SHO-related encounters only, including emergency department (ED) visits without hospitalization (outpatient SHO patients), and those with no SHO- or acute hyperglycemia-related events (comparison patients). Lengths of stay and SHO-related hospitalization costs were estimated and propensity score and inverse probability weighting methods were used to adjust for baseline differences across the groups to evaluate longer-term impacts.
We identified 8,734 patients, of which 4.2% experienced at least one SHO-related hospitalization. Among those who experienced SHO (i.e. of those in the inpatient and outpatient SHO groups), 31% experienced at least one SHO-related hospitalization, while 9% were treated in the ED without subsequent hospitalization. Approximately 79% of patients were admitted directly to the hospital; the remainder were first assessed or treated in the ED. The inpatient SHO patients stayed in the hospital, including time in the ED, for 1.7 days and incurred $3551 in costs. About one-third of patients were hospitalized again for SHO. Inpatient SHO patients incurred significantly higher monthly costs after their initial SHO-related hospitalization than patients in the two other groups ($2084 vs $1313 and $1372), corresponding to 59% or 52% higher monthly costs for inpatient SHO patients.
These analyses excluded patients who did not seek ED or hospital care when faced with SHO; events may have been miscoded; and we were not able to account for clinical characteristics associated with SHO, such as insulin dose and duration of diabetes, or unmeasured confounders.
The burden associated with SHO is not negligible. About 4% of T1DM patients using basal-bolus insulin regimens are hospitalized at least once due to SHO. Not only did those patients incur the costs of their SHO hospitalization, but they also incur red at least $712 (52%) more in costs per month after their hospitalization than outpatient SHO or comparison patients. Reducing SHO events can help decrease the burden associated with SHO among patients with T1DM.
在美国，约有125万人患有1型糖尿病（T1DM），这是一种慢性代谢疾病，因身体无法产生胰岛素而发病，需要终身胰岛素治疗。胰岛素依从性差可能导致严重低血糖（SHO），进而导致住院及长期并发症；这些反过来又推高了SHO和T1DM的总体成本。本研究的目的是使用基础-餐时胰岛素估算与SHO相关的住院患病率和成本，以及它们对T1DM患者的额外长期影响。
利用Truven MarketScan索赔数据，我们确定了在2010 - 2015年期间因SHO住院（住院SHO患者）且使用基础-餐时胰岛素方案的成年T1DM患者。定义了两个比较组：仅患有门诊SHO相关就诊的患者，包括未住院的急诊科（ED）就诊患者（门诊SHO患者），以及无SHO或急性高血糖相关事件的患者（对照患者）。估算住院时间和与SHO相关的住院成本，并使用倾向评分和逆概率加权方法调整各组间的基线差异，以评估长期影响。
我们确定了8734名患者，其中4.2%经历了至少一次与SHO相关的住院。在经历过SHO的患者中（即住院SHO组和门诊SHO组中的患者），31%经历了至少一次与SHO相关的住院，而9%在急诊科接受治疗但随后未住院。约79%的患者直接入院；其余患者首先在急诊科接受评估或治疗。住院SHO患者在医院（包括在急诊科的时间）停留1.7天，费用为3551美元。约三分之一的患者因SHO再次住院。住院SHO患者在首次与SHO相关的住院后每月费用显著高于其他两组患者（2084美元对1313美元和1372美元），相当于住院SHO患者每月费用高出59%或52%。
这些分析排除了在面临SHO时未寻求急诊科或医院护理的患者；事件编码可能有误；并且我们无法考虑与SHO相关的临床特征，如胰岛素剂量和糖尿病病程，或未测量的混杂因素。
与SHO相关的负担不可忽视。约4%使用基础-餐时胰岛素方案的T1DM患者因SHO至少住院一次。这些患者不仅承担了SHO住院的费用，而且在住院后每月费用比门诊SHO患者或对照患者至少高出712美元（52%）。减少SHO事件有助于减轻T1DM患者中与SHO相关的负担。
