Lee Kong Chian School of Medicine, Nanyang Technological University.
Ann Acad Med Singap. 2020 Oct;49(10):731-741.
This was a retrospective cross-sectional study to assess the impact of chronic kidney disease (CKD) and its severity in Type 2 diabetes mellitus (T2DM) on direct medical costs, and the effects of economic burden on CKD related complications in T2DM in Singapore.
A total of 1,275 T2DM patients were recruited by the diabetes centre at Khoo Teck Puat Hospital from 2011-2014. CKD stages were classified based on improving global outcome (KDIGO) categories, namely the estimated glomerular filtration rate (eGFR) and albuminuria kidney disease. Medical costs were extracted from the hospital administrative database.
CKD occurred in 57.3% of patients. The total mean cost ratio for CKD relative to non-CKD was 2.2 (<0.001). Mean (median) baseline annual unadjusted costs were significantly higher with increasing CKD severity-S$1,523 (S$949), S$2,065 (S$1,198), S$3,502 (S$1,613), and S$5,328 (S$2,556) for low, moderate, high, and very high risk respectively (<0.001). CKD (<0.001), age at study entry (=0.001), Malay ethnicity (=0.035), duration of diabetes mellitus (DM; <0.001), use of statins/fibrates (=0.021), and modified Diabetes Complications Severity Index (DCSI) (<0.001) were positively associated with mean annual direct medical costs in the univariate analysis. In the fully adjusted model, association with mean annual total costs persisted for CKD, CKD severity and modified DCSI.
The presence and increased severity of CKD is significantly associated with higher direct medical costs in T2DM patients. Actively preventing the occurrence and progression in DM-induced CKD may significantly reduce healthcare resource consumption and healthcare costs.
本研究是一项回顾性的横断面研究，旨在评估慢性肾脏病（CKD）及其在 2 型糖尿病（T2DM）中的严重程度对直接医疗费用的影响，以及在新加坡，CKD 相关并发症对经济负担的影响。
2011 年至 2014 年，Khoo Teck Puat 医院的糖尿病中心共招募了 1275 名 T2DM 患者。CKD 分期基于改善全球肾脏病结局组织（KDIGO）分类，即估算肾小球滤过率（eGFR）和蛋白尿肾脏病。从医院行政数据库中提取医疗费用。
57.3%的患者发生 CKD。与非 CKD 相比，CKD 的总平均费用比为 2.2（<0.001）。随着 CKD 严重程度的增加，未调整的基线年度费用显著升高-S$1523（S$949），S$2065（S$1198），S$3502（S$1613），和 S$5328（S$2556），分别为低、中、高和极高风险（<0.001）。CKD（<0.001）、研究开始时的年龄（=0.001）、马来族裔（=0.035）、糖尿病（DM）持续时间（<0.001）、他汀类药物/纤维酸类药物的使用（=0.021）和改良的糖尿病并发症严重程度指数（DCSI）（<0.001）在单变量分析中与平均年度直接医疗费用呈正相关。在完全调整模型中，与平均年度总费用的关联在 CKD、CKD 严重程度和改良 DCSI 中仍然存在。
CKD 的存在及其严重程度与 T2DM 患者的直接医疗费用显著增加有关。积极预防 DM 诱导的 CKD 的发生和进展可能会显著减少医疗资源的消耗和医疗费用。
