Department of Mathematical Sciences, University of Copenhagen, Universitetsparken 5, København Ø, 2300, Copenhagen, Denmark.
The World Bank Group, Washington, DC, USA.
BMC Health Serv Res. 2020 May 11;20(1):409. doi: 10.1186/s12913-020-05261-y.
Diabetes is one of the leading causes of poor health and high care costs in Ukraine. To prevent diabetes complications and alleviate the financial burden of diabetes care on patients, the Ukrainian government reimburses diabetes medication and provides glucose monitoring, but there are significant gaps in the care continuum. We estimate the costs of providing diabetes care and the most cost-effective ways to address these gaps in the Poltava region of Ukraine.
We gathered data on the unit costs of diabetes interventions in Poltava and estimated expenditure on diabetes care. We estimated the optimal combination of facility-based and outreach screening and investigated how additional funding could best be allocated to improve glucose control outcomes.
Of the ~ 40,000 adults in diabetes care, only ~ 25% achieved sustained glucose control. Monitoring costs were higher for those who did not: by 10% for patients receiving non-pharmacological treatment, by 61% for insulin patients, and twice as high for patients prescribed oral treatment. Initiatives to improve treatment adherence (e.g. medication copayment schemes, enhanced adherence counseling) would address barriers along the care continuum and we estimate such expenditures may be recouped by reductions in patient monitoring costs. Improvements in case detection are also needed, with only around two-thirds of estimated cases having been diagnosed. Outreach screening campaigns could play a significant role: depending on how well-targeted and scalable such campaigns are, we estimate that 10-46% of all screening could be conducted via outreach, at a cost per positive patient identified of US$7.12-9.63.
Investments to improve case detection and treatment adherence are the most efficient interventions for improved diabetes control in Poltava. Quantitative tools provide essential decision support for targeting investment to close the gaps in care.
糖尿病是导致乌克兰健康状况不佳和医疗费用高昂的主要原因之一。为了预防糖尿病并发症并减轻患者的糖尿病护理经济负担，乌克兰政府报销糖尿病药物并提供葡萄糖监测，但在护理连续体方面存在重大差距。我们评估了在乌克兰波尔塔瓦地区提供糖尿病护理的成本，以及解决这些差距的最具成本效益的方法。
我们收集了波尔塔瓦糖尿病干预措施的单位成本数据，并估算了糖尿病护理的支出。我们估计了基于设施的和外展筛查的最佳组合，并研究了如何最好地分配额外资金以改善血糖控制结果。
在接受糖尿病护理的约 40,000 名成年人中，只有约 25%的人实现了持续的血糖控制。未达到血糖控制的患者监测成本更高：非药物治疗患者增加 10%，胰岛素治疗患者增加 61%，口服治疗患者增加一倍。改善治疗依从性的举措（例如药物共付额计划、增强的依从性咨询）将解决护理连续体中的障碍，我们估计这些支出可能会通过降低患者监测成本得到弥补。还需要改进病例发现，只有大约三分之二的估计病例得到了诊断。外展筛查活动可以发挥重要作用：具体取决于此类活动的针对性和可扩展性，我们估计所有筛查中有 10%-46%可以通过外展进行，每个阳性患者的识别成本为 7.12-9.63 美元。
投资改善病例发现和治疗依从性是改善波尔塔瓦糖尿病控制的最有效干预措施。定量工具为针对投资以弥合护理差距提供了重要的决策支持。
