Type 2 diabetes and healthcare resource utilisation in the Kingdom of Bahrain

Objective: Developing country-specific unit-cost catalogs is a key area for advancing economic research to improve medical and policy decisions. However, little is known about how healthcare costs vary by type 2 diabetes (T2D) complications across time in Asian countries. We sought to quantify the economic burden of various T2D complications in Taiwan. Research Design and Methods: A nationwide population-based, longitudinal study was conducted to analyze 802,429 adults with newly-diagnosed T2D identified during 1999-2010 and followed-up until death or December 31, 2013. Annual healthcare costs associated with T2D complications were estimated with the multivariable generalized estimating equations models adjusting for individual characteristics. Results: The mean annual healthcare cost was $281 and $298 (2017 U.S. dollars) for a male and female, respectively, diagnosed with T2D at age <50 years, with diabetes duration of <5 years, and without comorbidities, antidiabetic treatments, and complications. Depression was the costliest comorbidity, increasing costs by 64-82%. Antidiabetic treatments increased costs by 72-126%. For non-fatal complications, costs increased from 36% (retinopathy) to 202% (stroke) in the event year, and from 13% (retinopathy or neuropathy) to 49% (heart failure) in subsequent years. Costs for the five leading costly non-fatal subtype complications increased by 201-599% (end-stage renal disease with dialysis), 37-376% (hemorrhagic/ischemic stroke), and 13-279% (upper/lower extremity amputation). For fatal complications, costs increased by 1,784-2,001% and 1,285-1,584% for cardiovascular and other-cause deaths, respectively. Conclusions: The cost estimates from this study are crucial for parameterizing diabetes economic simulation models to quantify the economic impact of clinical outcomes and determine cost-effective interventions.

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Healthcare costs associated with macrovascular, microvascular, and metabolic complications of type 2 diabetes across time: Estimates from a population-based cohort of over 0.8 million individuals with up to 15 years of follow-up

10.2337/figshare.12173988.v1 ◽

2020 ◽

Author(s):

Hsuan-Ying Chen ◽

Shihchen Kuo ◽

Pei-Fang Su ◽

Jin-Shang Wu ◽

Huang-Tz Ou

Keyword(s):

Type 2 Diabetes ◽

Healthcare Costs ◽

Unit Cost ◽

Simulation Models ◽

Population Based ◽

Individual Characteristics ◽

Economic Research ◽

Metabolic Complications ◽

Fatal Complications

Objective: Developing country-specific unit-cost catalogs is a key area for advancing economic research to improve medical and policy decisions. However, little is known about how healthcare costs vary by type 2 diabetes (T2D) complications across time in Asian countries. We sought to quantify the economic burden of various T2D complications in Taiwan. Research Design and Methods: A nationwide population-based, longitudinal study was conducted to analyze 802,429 adults with newly-diagnosed T2D identified during 1999-2010 and followed-up until death or December 31, 2013. Annual healthcare costs associated with T2D complications were estimated with the multivariable generalized estimating equations models adjusting for individual characteristics. Results: The mean annual healthcare cost was $281 and $298 (2017 U.S. dollars) for a male and female, respectively, diagnosed with T2D at age <50 years, with diabetes duration of <5 years, and without comorbidities, antidiabetic treatments, and complications. Depression was the costliest comorbidity, increasing costs by 64-82%. Antidiabetic treatments increased costs by 72-126%. For non-fatal complications, costs increased from 36% (retinopathy) to 202% (stroke) in the event year, and from 13% (retinopathy or neuropathy) to 49% (heart failure) in subsequent years. Costs for the five leading costly non-fatal subtype complications increased by 201-599% (end-stage renal disease with dialysis), 37-376% (hemorrhagic/ischemic stroke), and 13-279% (upper/lower extremity amputation). For fatal complications, costs increased by 1,784-2,001% and 1,285-1,584% for cardiovascular and other-cause deaths, respectively. Conclusions: The cost estimates from this study are crucial for parameterizing diabetes economic simulation models to quantify the economic impact of clinical outcomes and determine cost-effective interventions.

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P429 Clinical utility of thiopurine metabolite monitoring in inflammatory bowel disease and its impact on healthcare utilisation in Singapore

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.558 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S390-S391

Author(s):

J Q Yeo ◽

H L Wee ◽

H H Cheen ◽

A WONG ◽

T G Lim ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Clinical Remission ◽

Healthcare Costs ◽

Clinical Utility ◽

Healthcare Resource ◽

Resource Utilisation ◽

Healthcare Resource Utilisation ◽

Dose Optimisation ◽

Inflammatory Bowel

Abstract Background Thiopurines are recommended for maintenance of steroid-free remission in inflammatory bowel disease (IBD). Thiopurine metabolite monitoring (MM) is increasingly used in the Western population. However, it remains a new strategy in Singapore with limited information on its therapeutic and economic benefits. Hence, this study aims to investigate the clinical utility of MM and its impact on healthcare resource utilisation in Singaporean IBD patients. Methods A retrospective observational study was conducted at the Singapore General Hospital outpatient IBD Centre. Patients with IBD, baseline MM during 2014–2017 and weight-based thiopurine doses for ≥4 weeks were followed up for 1 year. Actions taken to optimise therapy, metabolite levels before and after the first action were documented. Outcomes assessed included steroid-free remission (SFR), clinical remission (defined as SFR, CRP <9.1mg/l and stool calprotectin <250ug/g), no escalation to anti-tumour necrosis factor or surgery, clinical healthcare resource utilisation and direct healthcare costs. Results Ninety IBD patients (50 CD, 40 UC) were included. Among them, 40% had baseline metabolite levels within therapeutic range, 31.1% sub-therapeutic, 21.1% supra-therapeutic and 7.8% shunters. Repeated MM with subsequent dose optimisation helped 67.2% of patients achieve therapeutic levels after 1 year. In particular, dose optimisation and reinforcement of adherence in the sub-therapeutic group recaptured clinical remission in almost 50% of the patients. Overall, 86.7% of patients achieved steroid-free remission and 90% had no therapy escalation or surgery (Table 1). Despite greater outpatient visits and laboratory investigations with MM, the median total healthcare costs at 1 year only increased marginally (S$6,407.66 [shunters] vs. S$5,215.20 [supra-therapeutic] vs. S$4,970.80 [sub-therapeutic] vs. S$4,370.48 [control (within therapeutic range)], p = 0.592) (Table 2). Conclusion MM guided timely dose optimisation or therapy escalation for non-responders, identification of non-adherence and reversal of shunting. Therefore, it is a useful clinical tool to optimise thiopurines without significantly increasing healthcare resource costs.

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Living with Ulcerative Colitis Study (LUCY) in England: a retrospective study evaluating healthcare resource utilisation and direct healthcare costs of postoperative care in ulcerative colitis

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000456 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000456

Author(s):

Matthew J Brookes ◽

John Waller ◽

Joseph C Cappelleri ◽

Irene Modesto ◽

Marco D DiBonaventura ◽

...

Keyword(s):

Ulcerative Colitis ◽

Healthcare Costs ◽

Healthcare Resource ◽

Design Method ◽

Pharmacological Therapy ◽

Practice Research ◽

Resource Utilisation ◽

Clinical Practice Research Datalink ◽

Healthcare Resource Utilisation ◽

Direct Healthcare Costs

ObjectiveUlcerative colitis (UC) is a lifelong, relapsing-remitting disease. Patients non-responsive to pharmacological treatment may require a colectomy. We estimated pre-colectomy and post-colectomy healthcare resource utilisation (HCRU) and costs in England.Design/MethodA retrospective, longitudinal cohort study indexing adult patients with UC undergoing colectomy (2009–2015), using linked Clinical Practice Research Datalink/Hospital Episode Statistics data, was conducted. HCRU, healthcare costs and pharmacological treatments were evaluated during 12 months prior to and including colectomy (baseline) and 24 months post-colectomy (follow-up; F-U), comparing baseline/F-U, emergency/elective colectomy and subtotal/full colectomy using descriptive statistics and paired/unpaired tests.Results249 patients from 26 165 identified were analysed including 145 (58%) elective and 184 (74%) full colectomies. Number/cost of general practitioner consultations increased post-colectomy (p<0.001), and then decreased at 13–24 months (p<0.05). From baseline to F-U, the number of outpatient visits, number/cost of hospitalisations and total direct healthcare costs decreased (all p<0.01). Postoperative HCRU was similar between elective and emergency colectomies, except for the costs of colectomy-related hospitalisations and medication, which were lower in the elective group (p<0.05). Postoperative costs were higher for subtotal versus full colectomies (p<0.001). At 1–12 month F-U, 30%, 19% and 5% of patients received aminosalicylates, steroids and immunosuppressants, respectively.ConclusionHCRU/costs increased for primary care in the first year post-colectomy but decreased for secondary care, and varied according to the colectomy type. Ongoing and potentially unnecessary pharmacological therapy was seen in up to 30% of patients. These findings can inform patients and decision-makers of potential benefits and burdens of colectomy in UC.

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