Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Iran J Med Sci. 2022 Jan;47(1):53-62. doi: 10.30476/ijms.2020.87284.1742.
Cardiovascular disease (CVD) is the most prevalent comorbid condition among patients with diabetes. The objective of this study is to determine the incremental healthcare resource utilization and expenditures (HRUE) associated with CVD comorbidity in diabetic patients.
In a cross-sectional study, patients receiving antidiabetic drugs were identified using the 2014 database of the Iran Health Insurance Organization of East Azerbaijan province (Iran). The frequency of HRUE was the main outcome. Outcome measures were compared between diabetic patients with and without CVD comorbidity during 2014-2016. The generalized regression model was used to adjust for cofounders because of a highly skewed distribution of data. Negative binomial regression and gamma distribution model were applied for the count and expenditure data, respectively.
A total of 34,716 diabetic patients were identified, of which 21,659 (63%) had CVD comorbidity. The incremental healthcare resource utilization associated with CVD compared to non-CVD diabetic patients for physician services, prescription drugs, laboratory tests, and medical imaging was 5.9±0.34 (28% increase), 46±1.9 (46%), 12.9±0.66 (27%), and 0.16±0.40 (7%), respectively (all P<0.001). Similarly, extra health care costs associated with CVD comorbidity for physician services, prescription drugs, laboratory tests, and medical imaging were 10.6±0.67 million IRR (294.4±18.6 USD) (50% increase), 1.44±0.06 million IRR (40±1.6 USD) (32%), 8.36±0.57 million IRR (232.2±15.8 USD) (58%), 0.51±0.02 million IRR (14.1±0.5 USD) (24%), and 0.29±0.02 million IRR (8±0.5 USD) (22%), respectively (all P<0.001).
CVD comorbidity substantially increases HRUE in patients with diabetes. Our findings draw the attention of healthcare decision-makers to proactively prevent CVD comorbidity in diabetic patients.
心血管疾病（CVD）是糖尿病患者最常见的合并症。本研究旨在确定糖尿病患者合并 CVD 相关的额外医疗资源利用和支出（HRUE）。
在一项横断面研究中，利用 2014 年伊朗东阿塞拜疆省健康保险组织（伊朗）数据库确定使用抗糖尿病药物的患者。主要结局为 HRUE 的频率。在 2014-2016 年期间，对患有和不患有 CVD 合并症的糖尿病患者的结果指标进行了比较。由于数据呈高度偏态分布，因此使用广义回归模型来调整混杂因素。对计数数据和支出数据分别应用负二项回归和伽马分布模型。
共确定了 34716 名糖尿病患者，其中 21659 名（63%）患有 CVD 合并症。与非 CVD 糖尿病患者相比，CVD 相关的医疗资源利用增加了 5.9±0.34（28%增加），处方药物增加了 46±1.9（46%），实验室检查增加了 12.9±0.66（27%），医学影像增加了 0.16±0.40（7%）（均 P<0.001）。同样，CVD 合并症相关的医疗保健费用增加了 10.6±0.67 百万伊朗里亚尔（294.4±18.6 美元）（50%增加），处方药物增加了 1.44±0.06 百万伊朗里亚尔（40±1.6 美元）（32%），实验室检查增加了 8.36±0.57 百万伊朗里亚尔（232.2±15.8 美元）（58%），医学影像增加了 0.51±0.02 百万伊朗里亚尔（14.1±0.5 美元）（24%），以及处方药物增加了 0.29±0.02 百万伊朗里亚尔（8±0.5 美元）（22%）（均 P<0.001）。
CVD 合并症会大大增加糖尿病患者的 HRUE。我们的研究结果引起了医疗保健决策者的注意，以主动预防糖尿病患者的 CVD 合并症。
