Low Serena, Lim Su C, Zhang Xiao, Wang Jiexun, Yeo Su J D, Yeoh Lee Y, Liu Yan L, Subramaniam Tavintharan, Sum Chee F
Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.
Diabetes Centre, Khoo Teck Puat Hospital, Singapore.
Nephrology (Carlton). 2019 May;24(5):534-541. doi: 10.1111/nep.13478.
We aim to examine difference in incremental direct medical costs between non-progressive and progressive chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) in Singapore.
This was a prospective study on 676 patients with T2DM attending a diabetes centre in a regional hospital. Annual direct medical costs were extracted from the administrative database. Ordinary least squares regression was used to estimate contribution of CKD progression to annual costs, adjusting for demographics and baseline clinical covariates.
Over mean follow-up period of 2.8 ± 0.4 years, 266 (39.3%) had CKD progression. The excess total follow-up medical costs from baseline was S$4243 higher in progressors compared to non-progressors (P = 0.002). The mean cost differential between the two groups increased from S$2799 in Stages G1-G2 to S$11180 in Stage G4. Inpatient cost accounted for 63.4% of total cost of progression. When stratified by glomerular filtration rate stages, the respective total mean annual costs at stages glomerular filtration rate Stages G3a-G3b and G4 were S$3290 (132%; P = 0.001) and S$4416 (135%; P = 0.011) higher post-progression.
Chronic kidney disease progression in T2DM is associated with high medical costs. The cost of progression is higher with higher severity of CKD stage at baseline and could be largely driven by inpatient admission.
我们旨在研究新加坡2型糖尿病（T2DM）患者中，非进展性和进展性慢性肾脏病（CKD）之间的直接医疗费用增量差异。
这是一项针对一家地区医院糖尿病中心676例T2DM患者的前瞻性研究。年度直接医疗费用从管理数据库中提取。采用普通最小二乘法回归估计CKD进展对年度费用的贡献，并对人口统计学和基线临床协变量进行调整。
在平均2.8±0.4年的随访期内，266例（39.3%）出现CKD进展。进展者与非进展者相比，从基线开始的额外总随访医疗费用高出4243新加坡元（P = 0.002）。两组之间的平均费用差异从G1 - G2期的2799新加坡元增加到G4期的11180新加坡元。住院费用占进展总费用的63.4%。当按肾小球滤过率阶段分层时，肾小球滤过率G3a - G3b期和G4期进展后的各自总平均年度费用分别高出3290新加坡元（132%；P = 0.001）和4416新加坡元（135%；P = 0.011）。
T2DM患者的CKD进展与高昂的医疗费用相关。基线时CKD阶段严重程度越高，进展费用越高，且很大程度上可能由住院治疗驱动。
