He Xiaoning, Zhang Yawen, Zhou Yan, Dong Chaohui, Wu Jing
School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China.
Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
Diabetes Ther. 2021 Jan;12(1):275-288. doi: 10.1007/s13300-020-00967-y. Epub 2020 Nov 18.
Reliable country-specific incidence and cost data on diabetes-related complications are essential inputs for the projections of the economic burden of diabetes. The aim of this study was to provide patient-level cost estimates of managing and treating complications in patients newly diagnosed with type 2 diabetes mellitus (T2DM) in China.
Patients newly diagnosed with T2DM in the Tianjin Urban Employee Basic Medical Insurance Claims database between 2008 and 2015 were identified and followed up. The cumulative incidence and descriptive costs of certain macrovascular and microvascular complications were examined. A generalized estimating equations model was used to estimate the immediate- and long-term costs for the incident complication in quarterly intervals, controlling for demographics and the confounding effects of comorbid complications.
A total of 114,847 newly diagnosed patients were identified (mean age 56.9 years, 45.5% women). After 7 years, 80.8% of the patients at risk had developed nephropathy and 75.7% had developed neuropathy. The immediate additional costs were highest for myocardial infarction during the quarterly interval that the complication first occurred (China yuan [CNY] 19,633), and the long-term costs were highest for stroke in the quarterly intervals of subsequent years (CNY 1087). The expected costs for all complications were calculated and presented as costs per quarterly interval and per year for different age and sex subgroups.
Managing complications results in substantial costs to the Chinese healthcare system. Our study contributes towards quantifying the economic burden and supports the parametrization of economic models of diabetes in China.
关于糖尿病相关并发症的可靠的特定国家发病率和成本数据是预测糖尿病经济负担的重要依据。本研究的目的是提供中国新诊断的2型糖尿病（T2DM）患者管理和治疗并发症的患者层面成本估计。
在2008年至2015年期间的天津城镇职工基本医疗保险理赔数据库中识别并随访新诊断为T2DM的患者。检查某些大血管和微血管并发症的累积发病率和描述性成本。使用广义估计方程模型按季度间隔估计新发并发症的近期和长期成本，同时控制人口统计学因素和合并并发症的混杂效应。
共识别出114,847名新诊断患者（平均年龄56.9岁，45.5%为女性）。7年后，80.8%的有风险患者发生了肾病，75.7%发生了神经病变。并发症首次发生的季度间隔内，心肌梗死的近期额外成本最高（人民币19,633元），随后几年的季度间隔内，中风的长期成本最高（人民币1087元）。计算了所有并发症的预期成本，并按不同年龄和性别亚组以每季度间隔和每年的成本形式呈现。
并发症管理给中国医疗系统带来了巨大成本。我们的研究有助于量化经济负担，并支持中国糖尿病经济模型的参数化。
