Diabetes Research Unit Cyrmu, Swansea University Medical School, Swansea, UK.
Global Patient Access, Novo Nordisk A/S, Søborg, Denmark.
J Med Econ. 2020 Jan;23(1):98-105. doi: 10.1080/13696998.2019.1645018. Epub 2019 Aug 2.
Effective glycemic control is the cornerstone of successful type 2 diabetes management. However, many patients fail to reach glycemic control targets, and therapeutic inertia (failure to intensify therapy to address poor glycemic control in a timely manner) has been widely reported. The aim of the present study was to evaluate the economic burden associated with diabetes-related complications due to poor glycemic control for patients with type 2 diabetes in the UK. A validated long-term model of type 2 diabetes (IQVIA CORE Diabetes Model) was used to project cost outcomes for a UK population with type 2 diabetes, based on data from The Health Improvement Network primary care database, at different levels of glycemic control. Costs associated with diabetes-related complications were accounted in 2017 Pounds Sterling (GBP). Complication costs were estimated for populations achieving different glycated hemoglobin (HbA1c) targets, in a number of delayed treatment intensification scenarios, and across a range of time horizons. For patients with an HbA1c level of 8.2% (66 mmol/mol), 7 years in poor control could increase mean costs associated with diabetes-related complications by over GBP 690 per patient and lead to costs of over GBP 1,500 in lost workplace productivity compared with achieving good glycemic control (HbA1c 7.0%, 53 mmol/mol) over a 10-year time horizon. Based on published estimates of the proportion of type 2 diabetes patients failing to meet glycemic targets in the UK, this corresponds to an additional economic burden of ∼GBP 2,600 million (complication costs plus lost productivity costs). The economic burden of poor glycemic control in type 2 diabetes in the UK is substantial. Efforts to avoid therapeutic inertia could substantially reduce diabetes-related complication costs even in the short-term.
有效的血糖控制是成功管理 2 型糖尿病的基石。然而，许多患者未能达到血糖控制目标，治疗惰性（未能及时强化治疗以解决血糖控制不佳的问题）已得到广泛报道。本研究旨在评估英国 2 型糖尿病患者因血糖控制不佳导致的糖尿病相关并发症的经济负担。采用经过验证的 2 型糖尿病长期模型（IQVIA CORE Diabetes Model），根据来自 The Health Improvement Network 初级保健数据库的数据，对不同血糖控制水平的英国 2 型糖尿病患者的成本结果进行预测。2017 年英镑（GBP）计入了与糖尿病相关并发症相关的成本。在若干延迟治疗强化场景下，根据不同糖化血红蛋白（HbA1c）目标实现的人群以及不同时间范围内的情况，估计了并发症成本。对于 HbA1c 水平为 8.2%（66mmol/mol）的患者，如果 7 年血糖控制不佳，每位患者与糖尿病相关并发症相关的平均费用将增加超过 690 英镑，与 10 年时间范围内实现良好血糖控制（HbA1c 7.0%，53mmol/mol）相比，将导致超过 1500 英镑的工作场所生产力损失。基于英国未能达到血糖目标的 2 型糖尿病患者比例的已发表估计，这相当于额外的经济负担约 26 亿英镑（并发症成本加上生产力损失成本）。英国 2 型糖尿病患者血糖控制不佳的经济负担很大。避免治疗惰性的努力甚至可以在短期内大大降低糖尿病相关并发症的成本。
