Olsson J, Persson U, Tollin C, Nilsson S, Melander A
Department of Internal Medicine, Jönköping County Hospital, Ryhov, Sweden.
Diabetes Care. 1994 Nov;17(11):1257-63. doi: 10.2337/diacare.17.11.1257.
To assess and compare excess costs of care and production losses because of morbidity in diabetic patients and the general population of a Swedish community.
Costs of production losses were calculated from medical and social insurance records on sickness benefit days (short-term illness) and premature retirement (permanent disability) in people with diabetes and in the entire population of the community (a municipality comprising a town and rural surroundings, with 28,000 inhabitants). Care costs included those of consultations and inpatient care, as well as costs of insulin, oral antidiabetic medications, other drugs, test material, and treatment devices, and they were obtained from patient records, the health care administration, and the statistics of community pharmacy sales.
Of the diabetic patients < 65 years of age, above which both diabetic and nondiabetic people get retirement pension, and sickness benefits cease, 62% of those on insulin treatment in each gender had insulin-dependent diabetes mellitus (IDDM). All insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) patients were > 40 years of age. Both the insulin-treated and the non-insulin-treated diabetic patients were prematurely retired twice as often as the average population and had twice as many inpatient days. The insulin-treated subjects also had twice as many sickness benefit days. The excess costs of production losses as a result of morbidity in people with diabetes were about $7,000 per individual and year. The corresponding excess costs of inpatient care were $800. The therapeutic expenditures for control of diabetes were about $600 per individual and year. If converted to U.S. conditions, the costs of lost production as a result of excess morbidity (< 65 years of age) would be $12 billion and $9 billion for people with insulin-treated and non-insulin-treated diabetes, respectively.
If improved metabolic control by intensified treatment would reduce excess morbidity in both IDDM and NIDDM, the predominant costs of production losses imply that intensified antidiabetic treatment might save costs.
评估并比较糖尿病患者与瑞典某社区普通人群因发病导致的护理额外费用和生产损失。
生产损失费用根据医疗保险和社会保险记录计算得出，涉及糖尿病患者及社区全体人口（一个包括城镇和农村周边地区、有28000名居民的自治市）的疾病津贴天数（短期疾病）和提前退休（永久残疾）情况。护理费用包括会诊和住院护理费用，以及胰岛素、口服降糖药、其他药物、检测材料和治疗设备的费用，这些费用从患者记录、医疗保健管理部门以及社区药房销售统计数据中获取。
在65岁以下的糖尿病患者中（65岁以上糖尿病患者和非糖尿病患者均可领取退休金，疾病津贴停止发放），各性别接受胰岛素治疗的患者中62%患有胰岛素依赖型糖尿病（IDDM）。所有接受胰岛素治疗的非胰岛素依赖型糖尿病（NIDDM）患者年龄均超过40岁。接受胰岛素治疗和未接受胰岛素治疗的糖尿病患者提前退休的频率均是普通人群的两倍，住院天数也是普通人群的两倍。接受胰岛素治疗的患者疾病津贴天数也是普通人群的两倍。糖尿病患者因发病导致的生产损失额外费用约为每人每年7000美元。相应的住院护理额外费用为800美元。控制糖尿病的治疗费用约为每人每年600美元。如果换算成美国的情况，因发病率过高（65岁以下）导致的生产损失费用，接受胰岛素治疗的糖尿病患者为120亿美元，未接受胰岛素治疗的糖尿病患者为90亿美元。
如果强化治疗改善代谢控制能够降低IDDM和NIDDM的过高发病率，那么主要的生产损失费用意味着强化抗糖尿病治疗可能会节省成本。
