The Cost-effectiveness Of Standardized Community Diabetes Management

OBJECTIVETo analyze the utilization of community health services in diabetes, and evaluate the cost-effectiveness and its influence factors of standardized community diabetes management in Xiagang community of Xiamen.RESEARCH DESIGN AND METHODSField survey, focus group discussion and data base querying were applied to investigate the utilization of community health services and the cost-effectiveness of standardized community diabetes management among 314 diabetics who had been followed up for more than 1 year in Xiagang community of Xiamen (one pilot site of diabetes management program) during Sep 2007 to Sep 2008.1. Utilization of health servicesData of Follow-up frequency and status of drug use and lifestyle interventions in diabetes was obtained from querying diabetes information system and focus group discussion.2. CostThe cost data was collected by questionnaire and from querying medical insurance institution, including:direct medical for inpatient/outpatient health services and prescription medication, direct nonmedical cost for diabetes patients spent on traveling to and from community health center and,indirect cost due to the lost of the value of productive time. Diabetes management program cost was calculated according to the financial records of Xiagang community health service center.3. OutcomesPatients'blood glucose, body weight and blood pressure (BP)from diabetes information system were assessed as management outcomes. 4. AnalysisEpidata3.1 and Excel 2003 were used to establish database and statistic analysis was operated by SPSS13.0.RESULTS1. Demography characteristics and the utilization of community health serviceTotal 314 subjects who had followed up in the management for 2.3±0.7years were investigated in the study.Among them,138 were males (43.9 percent) and 176 were femals (56.1 percent), with the age of 65.9±10.8 yesrs and the median of diabetic duration was 6.7 years.224 subjects (71.3 percent) suffered more than one complications. 245 patients used medication and 238 patients resorted to physical activities, account for 37.6 percent and 25.1 percent of patients had fasting blood glucose and blood pressure tested for more than 4 times, respectively,.During the year,220 patients (70 percent) had visited Xiagang community health service center more than 4 times (which was the target frequency), and 156 of them (71 percent) had been registered.2. Cost and health effectivenessThe cost spent on diabete management services which was supplied by community health service center was 74592 RMB (237.6 per capita). Cost of diabetic patients was 5992.7RMB per capita, including the direct cost of 5039.8 RMB (84.1 percent) and the indirect cost of 953.0 RMB (15.9 percent). The total cost for each patient was 6230.3 RMB. Cost per capita increased when the patients'age became older, diabetic duration get longer, and complications increasing.The mean FPG and whether it reached the target level(FPG≤7.0mmol/L) were used to evaluating the effectiveness. Totally, the FPG reduced by 1.07mmol/L (P<0.05) and the target rate (FPG≤7.0mmol/L) increased by 12.3 percent (P<0.05).Among those who had been engaged for about one year, the FPG reduced by 0.7 mmol/L from 8.29 to 7.59 and the target rate increased by 10.2 percent from 36.2 to 46.4. For others, the level of effectivenss kept as it was one year before.3.Cost-effectiveness ratioFor one year standardized community diabetes management, the direct cost per 1 mmol/L FPG decreased and per 1 percent of target rate increased were 5563.0RMB and 381.8 RMB respectively,and the total cost were 6855.1 RMB and 470.5 RMB respectively. CONCLUSIONThe total cost spent on standardized community diabetes management was 6230.3 RMB per capita during Sep 2007 to Sep 2008, including 5992.7RMB per capita from diabetics and 237.6 RMB per capita which was supplied by community health service center.The complications became the most important impact factor of cost. Overall, the management was effective, and the effect lasted after the first one year management. The standardized community diabetes management was acceptable for its cost-effectiveness. It was insufficien the utilization of community health service of diabetes care in Xiagang.We advice that doctors reinforce the patients' management and supply more instructions about how to deal with the diabetes to patients in order to get a good compliance, and make diabetes'management more cost-effective。...