First, the basic methods of diabetes health economics evaluation
Study on the cost of disease: describe the impact of a disease on individuals, health undertakings and society. There are many ways to estimate the direct and indirect costs of diseases.
Expenditure on disease research: direct and indirect expenses for solving health problems; Direct costs are the costs of diagnosis, treatment, monitoring, prevention and special case study; Indirect cost is the cost of labor loss caused by not working, losing labor ability, early retirement and death.
Study on disease cost: compare different schemes to achieve the same effect. This is the most widely used health economics evaluation method at present. The cost is generally expressed in common monetary units, and the effect is the concrete result of some medical measures, such as prolonging the specific time of patients' lives and avoiding the number of illnesses or deaths. In the concrete analysis, the two are linked and expressed by the cost of each medical effect unit (such as the treatment cost of prolonging the patient's life 1 year) or the medical effect produced by each unit currency (such as prolonging the patient's life for a few dollars). Its advantage is that when comparing and making decisions between different medical measures, it can be evaluated with relatively the same comparison unit.
Cost-effectiveness study: comparative analysis of the effectiveness of intervention measures (such as blood sugar control, blood pressure control, etc.). ) aims to achieve different effects. It is not enough to simply evaluate a medical service to save patients from the Olympics. We should also pay attention to whether there are sequelae, the degree of recovery, whether we can live a normal life and whether we can return to work, that is, to evaluate the quality of life. In particular, it is necessary to evaluate the medical effect from the perspective of society. For example, a professional who works at his desk and a long-distance runner both have amputations due to diabetes, but the social impact is quite different. At this time, it is difficult to use cost-benefit analysis or cost-benefit analysis, and cost-utility analysis should be adopted. In the cost-utility analysis, measuring the effect with social benefits can also be said to be a cost-utility analysis, or a higher stage of its development.
Cost-benefit analysis: the cost-benefit ratio is used to compare the cost-benefit of a single intervention. The results of different medical measures are expressed in a certain way and converted into common currency, so that the cost and effect are also expressed in monetary units. In the concrete comparison, it can be directly based on the difference of cost-benefit or the ratio of income to cost. The former can tell whether the net benefit of a certain measure is positive or negative, and it is easy to compare and choose with another alternative medical measure. The ratio is less than 1, indicating that the income is less than the cost. The greater the proportion, the higher the benefit.
Minimum cost study: it is suitable for evaluating and seeking the most economical method when the effects of two health measures are basically the same.
Because diabetes is a chronic disease, involving many costs and consequences, some authors often use various analysis methods when analyzing the costs and consequences of diabetes. For example, Gilmer and others analyzed the relationship between medical expenses of diabetic patients and glycosylated hemoglobin (hba 1c) level and complications, and O'Brien and others evaluated the relationship between hba 1c level and the incidence of diabetic complications and the corresponding medical expenses, so they adopted various analysis methods such as cost effectiveness and cost benefit.
There are many reasons for the obvious increase of medical expenses, such as the improvement of clinical diagnosis technology and the increase of patients' use of medical facilities, as well as the application and popularization of new equipment and technology; In the past, due to insufficient attention to diabetic complications and lack of records, some expenses can easily be attributed to other reasons, such as peripheral vascular diseases.
Diabetes can also have an impact on occasional pathologically unrelated diseases. For example, if a diabetic has a femoral neck fracture, the hospitalization expenses will be different from those of similar patients without diabetes. The former has long hospitalization time, many examination items and different treatment requirements.
The focus of health economics evaluation is to solve the efficiency relationship between cost and effect. Efficiency is the core of economic evaluation. The effect can be measured from the perspectives of patients, doctors and society, so different specific analysis methods have been developed.
Second, the socio-economic cost of diabetes.
The slogan of World Diabetes Day 1999 put forward by WHO and the International Diabetes Federation (IDF) is the price of diabetes, aiming to attract the attention of governments and people from all walks of life.
Diabetes is a chronic industrial disease that seriously affects people's health and brings serious economic burden to governments and people all over the world. For example, from 65438 to 0997, the expenditure on diabetes in the United States was $98 billion, of which $44 billion was direct medical expenditure and $54 billion was indirect expenditure. Indirect expenditure refers to the economic expenditure caused by disability and death caused by diabetes. The per capita medical expenditure of diabetic patients is $65,438 +00,765,438+0, and that of non-diabetic patients is $2,699. Diabetes patients account for 3.8% of the total population in the United States, while direct medical expenses account for 5.8% of the total medical expenditure. In terms of indirect costs, the disability cost caused by diabetes is $3.7/kloc-0.00 billion, and the death cost is about $/kloc-0.69 billion. 18 ~ 64 years old diabetic patients lost an average of 8.3 working days, while non-diabetic patients lost an average of 1.7 working days. A survey in New South Wales, Australia, confirmed that 5% of hospitalized diabetic patients consumed 65,438+00% of the health expenses in this area.
The medical expenses of diabetic patients are directly related to their blood sugar control. Cilmer and others found that the medical expenses of diabetic patients were positively correlated with the level of HbAlc. When the HbAlc is greater than 7%, the medical expenses will increase obviously, by 1 percentage point. This increased cost is affected by complications, especially heart disease and hypertension. For example, if HbAlc is increased from 6% to 7%, each patient will need to spend an additional $378 in medical expenses for patients without heart disease or hypertension; However, for patients with heart disease and hypertension, the additional medical expenses are $65,438+$0,504. In the absence of concurrent factors, this relationship is roughly linear. With the increase of coexisting factors, from single hypertension to the coexistence of hypertension and heart disease, the nonlinear relationship increases. At the upper limit of this range, hba 1c 10% exceeds 9%, and patients with hypertension and heart disease need to spend 4 1 16 dollars every year. O'Brien et al. assessed the incidence of diabetic complications and the corresponding medical expenses when the HbAlc was controlled at 6%, 8%, 10% and 12% in the lifetime of diabetic patients by setting up a hypothetical questionnaire. Results When glycosylated hemoglobin was controlled at 6%, the incidence of background retinopathy, blindness, renal failure and neuropathy were 22.2%, 9.8%, 65,438 0.4% and 9.65,438 0%, respectively, and the corresponding medical expenses were $85,697. HbAlc was controlled at the level of 8%, and the incidence rates of these four complications were 49.8%, 18.2%, 8.7% and 20.8% respectively, and the medical expenses were 9 1 146 USD. HbAlc was controlled at 10%, the incidence of complications was 95.9%, 53.2%, 29.0% and 47.2% respectively, and the medical expenses were120,903 USD. HbAlc was controlled at the level of 12%, the incidence rates were 99.6%, 59.4%, 40.2% and 74.4% respectively, and the medical expenses were132,253 USD.
The growth and distribution of hospitalization expenses of diabetic patients in the 306th Hospital of the People's Liberation Army 1995 to 1999 show that the medical expenses of diabetes are quite high. In the past five years, 948 patients with diabetes were treated in our hospital (1.509 cases), and the total annual hospitalization expenses per capita were 1.382 yuan. 1996 is 2767 yuan; 1997 is 4429 yuan; 1998 is 48 15 yuan; 1999 is 4847 yuan. Based on the cost of 1995, the total hospitalization cost increased by 103.4% in five years. Diabetes also significantly increases the hospitalization expenses of related diseases. According to our data, from 1995 to 1999, the per capita medical expenses of diabetes complicated with cerebral infarction, coronary heart disease, hypertension, cholecystitis and/or cholelithiasis and upper respiratory tract infection were 4 390 yuan, 4,837 yuan, 3 560 yuan, 4 103 yuan and 2,285 yuan respectively. The hospitalization expenses of patients with similar diseases without diabetes were 2 1.75 yuan, 2,079 yuan, 1.887 yuan, 3 1.02 yuan and 6 1.8 yuan, respectively. The medical expenses of diabetic patients with the above diseases are 2.02, 2.33, 654, 38+0.89 and 658 yuan respectively. As the age of diabetic patients is older than that of the control group, we still find that the total hospitalization expenses of diabetic patients are 1.73 times that of the control group.
At present, there are about 35 million diabetic patients in China. By the year of 20 15, according to the epidemiological research results of diabetes at home and abroad, the number of diabetics in China will reach 60 million. Therefore, while strengthening the prevention and treatment of diabetes and its complications, we must strengthen the research on the health economics of diabetes.
Third, study the importance of diabetes health economics
With the current medical level, for most patients, diabetes needs lifelong treatment. This kind of lifelong treatment needs not only drugs, but also knowledge, and the active cooperation of patients and their families, so as to minimize the dependence of patients on hospitals and medical staff. Giving patients scientific weapons and using them reasonably as far as possible can improve the treatment effect and avoid unreasonable medical expenses.
Complications of diabetes lead to disability and death. Long-term hyperglycemia and chronic complications make the medical expenses of diabetic patients rise sharply. In the United States, compared with patients without complications, the medical expenses of diabetes complicated with microangiopathy or macroangiopathy and macroangiopathy coexisting with macroangiopathy increased by 65438 0.7 times, 2.0 times and 3.5 times respectively. The serious complications of diabetes will also make patients lose their ability to work and live, which will bring incalculable economic burden. However, the acute complications of diabetes can be completely avoided, and the chronic complications can be prevented and treated. The key is to find and treat diabetes and its complications as soon as possible. The American Diabetes Control and Complications Study (DCCT) confirmed that good blood sugar control can reduce the neurological, renal and fundus complications of diabetes by 50% ~ 70%. The results of united kingdom prospective diabetes study (UDPES) confirmed that better control of blood sugar can significantly reduce the microvascular complications of diabetes, but not the macrovascular complications. Controlling hypertension can significantly reduce the incidence of cardiovascular events in diabetic patients.
Diabetes is a chronic and complex disease involving many factors. Insulin resistance is the basic factor leading to obesity, type 2 diabetes, hypertension and cardiovascular and cerebrovascular diseases. Some factors are even mutually causal. For example, obesity can cause insulin resistance and abnormal glucose metabolism, and abnormal lipid metabolism can aggravate diabetes and insulin resistance and promote arteriosclerosis. Therefore, comprehensive prevention and treatment should be emphasized in the prevention and treatment of these common non-communicable chronic diseases that endanger health. Comprehensive prevention and control can reduce costs and improve benefits.
Diabetes is a systemic disease involving multiple tissues and organs, and the concept of shared nursing is very important. Diabetic patients should get high-quality multidisciplinary hospital services in the shortest possible time. This service can find diabetes complications as soon as possible, improve medical and scientific research benefits and reduce hospital expenses.
The study of diabetes should pay attention to long-term social and economic benefits, and the study of health economics is very important, which is also very suitable for the current medical reform. Whether it is the reduction or loss of patients' labor force or the economic impact of diabetes on families and society, we need to conduct in-depth research. When we make a treatment plan, we should make an economic evaluation, and consider the economic affordability of patients and their families, even the patient's work unit and society.
I hope it helps you.