Ji Linong, Chandran Arthi, Inocencio Timothy J, Sun Zilin, Li Qifu, Qin Guijun, Wei Zheng, DiMario Stefan, Chapman Richard H
Endocrinology, Peking University People's Hospital, Beijing, China.
Health Economics and Outcomes Research, BD, 1 Becton Drive #J315b, Franklin Lakes, NJ, 07417, USA.
BMC Health Serv Res. 2018 Apr 24;18(1):300. doi: 10.1186/s12913-018-3095-9.
Pen needles are an important component of insulin delivery among patients with diabetes, but are not universally covered in China. We compared clinical and economic characteristics of insulin-dependent patients in China who have some level of pen needle (PN) reimbursement to those with no PN reimbursement.
A cross-sectional study was conducted among 400 insulin users with Type 1 or Type 2 diabetes treated in outpatient endocrinology units of four large tertiary care hospitals in Nanjing, Chongqing, Beijing and Zhengzhou. Demographics, medical history, healthcare resource utilization (RU), out-of-pocket costs, insurance and PN reimbursement status were surveyed. Unit costs were assigned to healthcare RU and compared using descriptive statistics and multivariate regression models.
A total of 400 patients were analyzed; 142 (35.5%) with some level of PN coverage/reimbursement and 258 (64.5%) without. Patients without PN reimbursement had a higher prevalence of lipohypertrophy (59.3% vs. 40.7%, p = 0.0007), greater median PN reuse (12 vs. 7 times per needle, p < 0.0001), greater 6-month insulin costs (1591 vs. 1328 Renminbi [RMB], p = 0.0025) and total unadjusted 6-month expenditures (6433 vs. 4432 RMB, p < 0.0001), respectively. After controlling for clinical and demographic characteristics, patients without PN reimbursement had 4.6 times greater odds of high costs compared to those with PN reimbursement.
Insulin users without PN reimbursement may pose a greater economic burden to China compared to those with PN reimbursement. Expansion of insurance coverage for insulin PNs can improve the quality of care and potentially help reduce the economic burden in this population.
笔式胰岛素注射器是糖尿病患者胰岛素给药的重要组成部分，但在中国并非普遍涵盖。我们比较了在中国有一定程度笔式胰岛素注射器（PN）报销的胰岛素依赖患者与无PN报销患者的临床和经济特征。
在南京、重庆、北京和郑州的四家大型三级医院的门诊内分泌科对400名1型或2型糖尿病胰岛素使用者进行了一项横断面研究。调查了人口统计学、病史、医疗资源利用（RU）、自付费用、保险和PN报销状况。将单位成本分配给医疗RU，并使用描述性统计和多元回归模型进行比较。
共分析了400名患者；142名（35.5%）有一定程度的PN覆盖/报销，258名（64.5%）没有。无PN报销的患者脂肪增生患病率更高（59.3%对40.7%，p = 0.0007），PN重复使用中位数更多（每支针12次对7次，p < 0.0001），6个月胰岛素成本更高（1591元对1328元人民币[RMB]，p = 0.0025），未调整的6个月总支出更高（6433元对4432元人民币，p < 0.0001）。在控制临床和人口统计学特征后，无PN报销的患者与有PN报销的患者相比，高成本几率高4.6倍。
与有PN报销的胰岛素使用者相比，无PN报销的胰岛素使用者可能给中国带来更大的经济负担。扩大胰岛素笔式注射器的保险覆盖范围可以提高护理质量，并有可能帮助减轻该人群的经济负担。
