| Abstrakt: |
Abstract: The economic burden resulting from Diabetic Nephropathy (DN) consumes a major portion of resources allocated for health-care services. Cost-effectiveness of various interventions on DN and its complications have relatively been well explored in developed countries, but these are almost absent in developing countries. The present study was undertaken to assess the cost-effectiveness of medical intervention in patients with DN. Two hundred patients with DN, with at least 1 yr of follow-up, were purposively selected from BIRDEM (tertiary diabetes care hospital) of Bangladesh. Of them 100 were late in detection (Serum Creatinine ≥4.0mmom/l, Late detected DN or Late detected diabetic nephropathy) and 100 were detected early (Serum Creatinine <4.0mmom/l, early detected DN or early detected diabetic nephropathy). The degree and extent of complications like cardiopathy, peripheral neuropathy, retinopathy and vasculopathy, treatment outcome, clinical effectiveness of interventions and direct, indirect and incremental cost of complications were calculated. Comparison was made between the groups. Cost included drugs, hospitalizations, diagnostics and visits. A total of 200 patients were considered for an average of 365 days, amounting to 651 person years of observation in total. The mean±SD fasting serum glucose of the groups was 9.36±0.40mmol/l and 4.78±0.38mmol/l, total cholesterol was 206.50±42.60 and 104.20±35.50mg/dl, HbA1c was 9.80±0.50% and 5.70±0.38%, TG was 163.76±99.46 and 155.67±94.84mg/dl and serum creatinine was 0.89±0.03 and 4.90±1.17mmol/l in Late detected diabetic nephropathy and early detected diabetic nephropathy respectively. About 19% patients in Late detected diabetic nephropathy and 36% in early detected diabetic nephropathy were free of diabetic complications other than DN. In Late detected diabetic nephropathy, 32% had one complication, 29% had two and 20% had more than two complications. On the other hand, in early detected diabetic nephropathy the corresponding values were 48%, 10% and 6% respectively. The most frequent complication was cardiopathy, which affected 33% patients in Late detected diabetic nephropathy and 27% in early detected diabetic nephropathy, followed by peripheral neuropathy 21% and 18%, retinopathy 17% and 13%, and vasculopathy 10% and 6% respectively. The average annual cost of care was US$ 27,954 (direct US$ 16,983 and indirect US$ 10,971), with an average US$ 140 per patient. Among the average annual cost Late detected diabetic nephropathy consumed US$ 19,837 (US$ 198 per patient) and early detected diabetic nephropathy US$ 8117 (US$ 81 per patient). 48% (US$ 13,473) of costs were attributable to drugs for both groups of which US$ 10,817 (80%) was for Late detected diabetic nephropathy and US$ 2656 (20%) for early detected diabetic nephropathy, 31% (US$ 8739) to hospitalizations of which US$ 5211 (60%) for Late detected diabetic nephropathy and 3528 (40%) for early detected diabetic nephropathy. In case of diagnostics and visits the corresponding values were US$ 2136 (60%) and 1419 (40%) and US$ 1673 (76%) and 514 (24%) for Late detected diabetic nephropathy and early detected diabetic nephropathy respectively. The annual medical costs increased with the number of complications from US$ 1320–2296 and to 3989 in Late detected diabetic nephropathy with one, two and more than two complications (other than DN) which is increasing at a rapid rate and US$ 917–1556 and to 2372 in early detected diabetic nephropathy respectively, increasing at a diminishing marginal rate. The regression equation showed that medical cost is significantly related to complications tested in both univariate (P <0.0001) and multiple linear regression analyses (R 2 =0.52; F =82.3, P <0.0001). Proper management with regular screening substantially reduces the expenditure related to care of patients with Diabetic Nephropathy and related complications even in a developing country. Strategies aimed at preventing Diabetic Nephropathy and early detection of the onset of nephropathy complication will reduce medical costs in a substantial way. [Copyright &y& Elsevier] |
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