Rucci Paola, Avaldi Vera Maria, Travaglini Claudio, Ugolini Cristina, Berti Elena, Moro Maria Luisa, Fantini Maria Pia
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, via san Giacomo 12, 40126, Bologna, Italy.
Advanced School for Healthcare Policies, Alma Mater Studiorum University of Bologna, via San Giacomo 12, 40126, Bologna, Italy.
Pharmacoecon Open. 2020 Mar;4(1):181-190. doi: 10.1007/s41669-019-0166-8.
Many studies and systematic reviews have estimated the healthcare costs of diabetes using a cost-of-illness approach. However, in the studies based on this approach patients' heterogeneity is rarely taken into account. The aim of this study was to stratify patients with type 2 diabetes into homogeneous cost groups based on demographic and clinical characteristics.
We conducted a retrospective cost-of-illness study by linking individual data on health services utilization retrieved from the administrative databases of Emilia-Romagna Region (Italy). Direct medical costs (either all-cause or diabetes-related) were calculated from the perspective of the regional health service, using tariffs for hospitalizations and outpatient services and the unit costs of prescriptions for drugs. The determinants of costs identified in a generalized linear regression model were used to characterize subgroups of patients with homogeneous costs in a classification and regression tree analysis.
The study population consisted of a cohort of 101,334 patients with type 2 diabetes, followed up for 1 year, with a mean age of 70.9 years. Age, gender, complications, comorbidities and living area accounted significantly for cost variability. The classification tree identified ten patient subgroups with different costs, ranging from a median of €483 to €39,578. The two subgroups with highest costs comprised dialysis patients, and the largest subgroup (57.9%) comprised patients aged ≥ 65 years without renal, cardiovascular and cerebrovascular complications.
Classification of patients into homogeneous cost subgroups can be used to improve the management of, and budget allocation for, patients with type 2 diabetes.
许多研究和系统评价采用疾病成本法估算糖尿病的医疗费用。然而，基于这种方法的研究很少考虑患者的异质性。本研究的目的是根据人口统计学和临床特征将2型糖尿病患者分层为成本同质组。
我们通过将从意大利艾米利亚 - 罗马涅地区行政数据库中检索到的个体卫生服务利用数据相链接，进行了一项回顾性疾病成本研究。从地区卫生服务的角度计算直接医疗成本（全因或糖尿病相关），使用住院和门诊服务的收费标准以及药品处方的单位成本。在广义线性回归模型中确定的成本决定因素用于在分类和回归树分析中表征成本同质的患者亚组。
研究人群包括一组101334例2型糖尿病患者，随访1年，平均年龄70.9岁。年龄、性别、并发症、合并症和居住地区对成本变异性有显著影响。分类树识别出十个成本不同的患者亚组，中位数从483欧元到39578欧元不等。成本最高的两个亚组包括透析患者，最大的亚组（57.9%）包括年龄≥65岁且无肾脏、心血管和脑血管并发症的患者。
将患者分类为成本同质亚组可用于改善2型糖尿病患者的管理和预算分配。
