Costa B, Estopá A, Borrás J, Sabaté A, Páez F
Unidad de Diabetes, Hospital de Móra d'Ebre, Servei Català de la Salut, Tarragona.
Med Clin (Barc). 1996 Apr 6;106(13):481-5.
The U100 insulin (100 units [U]/ml) in only used in a minority of Spanish hospitals and is not ordinarily evaluated. To study the convenience of converting from U40 (40 U/ml) to U100 insulin in a first level hospital, the procedure, costs and professional acceptance were analyzed after one year of experience.
The chronology and the transfer method are described making an interannual pharmacoeconomical comparison of costs U40/U100 based on insulin intake and injection material. The primary source of information was the computerized base of admission, pharmacy and supply. The secondary source included the obligatory registries of daily medicine sheets. Nursing staff acceptance of the new system (preloaded U100 syringes) was analyzed with a predesigned quantitative scale questionnaire.
In the U40 phase, 69,600 U and 8,260 syringes were used to satisfy 136 diabetics at a mean prescription of 21 U/day for 10.9 days. In the U100 phase, 92,100 U and 1,682 syringes were used for 132 admissions with a mean dose of 20 U during 8.6 days. The insulin prescribed and injected was 45.5% and 24.7%, respectively with the consumption of non injected insulin in the center being 20.8%. On taking only the fraction injected into consideration, the mean daily cost per complete treatment was lower in U100 (116/84 and 1,368/809 pesetas; p < 0.0001) representing 0.53% (U40) and 0.36% (U100) of hospital stay costs. The total cost increased by 44 ptas./patient/day during the first year of conversion. Each section of the 67 questionnaires evaluated scored from 4 (greatest acceptance) to 20 (lowest acceptance). The general mean was 6.8 +/- 1.6 with no significant differences between the section of management/manipulation of U100 devices (6.7 +/- 2.1), learning and protocol (7.3 +/- 2.6) and patient education (6.5 +/- 1.8; p = 0.07, NS).
Current hospital conversion to U100 insulin requires the use of mechanized injection systems which represent a slight extra cost of scarce social relevance and are greatly accepted by users if adequate transfer procedures are applied.
U100胰岛素（100单位[U]/毫升）仅在少数西班牙医院使用，且通常未被评估。为研究在一级医院从U40（40 U/毫升）转换为U100胰岛素的便利性，在经历一年后对转换过程、成本和专业认可度进行了分析。
描述了时间顺序和转换方法，并基于胰岛素摄入量和注射材料对U40/U100的成本进行年度药物经济学比较。主要信息来源是入院、药房和供应的计算机数据库。次要来源包括每日药单的强制记录。使用预先设计的定量量表问卷分析护理人员对新系统（预装U100注射器）的接受度。
在U40阶段，使用了69600 U和8260支注射器，为136名糖尿病患者提供治疗，平均处方量为每日21 U，治疗10.9天。在U100阶段，使用了92100 U和1682支注射器，涉及132例入院患者，平均剂量为20 U，治疗8.6天。所开处方并注射的胰岛素分别为45.5%和24.7%，中心未注射胰岛素的消耗量为20.8%。仅考虑注射部分，U100中每次完整治疗的平均每日成本较低（116/84和1368/809比塞塔；p<0.0001），分别占住院费用的0.53%（U40）和0.36%（U100）。在转换的第一年，总成本增加了44比塞塔/患者/天。67份问卷的每个部分评分从4分（最高接受度）到20分（最低接受度）。总体平均分为6.8±1.6，在U100设备的管理/操作部分（6.7±2.1）、学习和方案部分（7.3±2.6）以及患者教育部分（6.5±1.8；p = 0.07，无显著性差异）之间无显著差异。
目前医院向U100胰岛素的转换需要使用机械化注射系统，这会带来少量额外成本，社会相关性不大，但如果应用适当的转换程序，用户会广泛接受。
