Assessment of Health Care Cost and Uncontrolled Glycemia



Summary

Increasing prevalence in diabetes and related healthcare costs in the United States provide compelling evidence for the need for cost-effective diabetes interventions. Benefits of glycemic management include shortening the hospitalization stay and decrease health care cost. Wagner, et al, (2001), concluded that in adult type 2 DM, patients controlled glycemia is associated with significant lower health care cost. Cost appraisal of care includes three cost saving predictors, which are: treatment modalities (medication), multidisciplinary team participation and laboratory values (blood glucose or A1C). The review will evaluate how the predictors impact health care cost and patient outcomes. In total, the cost per patient was reduced from $ 29 327 $ to 12 762.

The average cost per severe glycaemic event in the three countries was similar for patients with type 2 diabetes at $537-688. The highest costs per event were for hospitalized patients, and were similar for type 1 and type 2 diabetes. Despite increasing insulin doses, 14% of the SSI patients sustained a blood glucose > 240 mg/dl. Levin, et al (2011), completed a randomized control trial, which investigated glycemic control and cost-effectiveness in type 2 diabetics with an HbA1c > 7%. The glargine plus glulisine group had adjusted daily cost $10.81 while the premixed group had adjusted daily cost of $12.42 (odds ratio = 1.61: 95% CI 3.22 to 0.0; p=0.05). This retrospective cohort is comparing the length of stay and cost between the study groups. The groups consist of patients started on either insulin detemir or insulin glargine. Cost factors measured include pharmacy cost and then health care cost and compared to glucose levels as evaluated with HbA1c.

The conclusion to the study determined that hospitalization cost was not significant within the groups of patients when the HbA1c < 7% to < 10%. Sandhu et al, (2008), investigated the multidisciplinary team approach to develop new insulin protocols for hospitalized patients and compared the cost of the hospitalizations. The group initiated intravenous insulin for blood glucose > 140 mg/dl in one group and the second group received subcutaneous insulin incorporating basal, nutritional support and corrective insulin. Even though there was minimal significance (p value not reported) in cost, the direct cost reduction was 1143.00 for the intervention group versus 426.00 for the control group. Cost was associated with both inpatient and outpatient care. Glycaemic is a disease that affects a high percentage of both world population and economically involves a major expenditure. Therefore, resources should be directed to the investigation of interventions that aim to improve the effectiveness of education and reduce or delay the incidence of chronic complications.

Assessment of Health Care Cost and Uncontrolled Glycemia

Introduction

When calculating the economic costs associated with Glycaemia, it is necessary to consider the costs to the patient and to the healthcare system. However, it is very difficult to estimate the former. The experience of one severe episode of Glycaemia may have a substantial psychological impact, leading to a chronic fear of Glycaemia, but fortunately most episodes do ...