The Hospitalization Costs For Patients Discharged With Diabetes And An Economic Evaluation Of Potential Preventions For Diabetes

Objective:There are almost135billion people suffering from diabetes, which was going to be300billion within the next10years. The serious consequences of diabetes, and most of its economic burden were produced by hospitalizations, which need for an urgent preventative action in China. This study explores the construction of hospitalization costs of diabetes in Tianjin and evaluates clinical and economic outcomes of strategies that could potentially prevent diabetes based on Chinese circumstances. It aims to provide indicators for the long-term allocation of healthcare resources for the local authorities.Methods:1. We retrospectively used the Tianjin Healthcare Insurance Register System (THIRS) database to identify all records of healthcare beneficiaries who were discharged with diabetes from hospitals in Tianjin from2007to2011. A randomized stratify sampling method were used to select50%of these records as an sample. The hospitalization costs of22,790patients were analyzed to evaluated the profile of hospitalization costs, and exploring the underlying risk factors by using multi-variation linear regression models.2. A representative sample of Chinese adults was used to create a simulated population of20,000people aged25years and above. The decision tree Markov model was developed to compare the clinical and economic outcomes of four diabetes prevention strategies with a control group. These preventive strategies were:(i) one-off screening for diabetes and impaired glucose tolerance (IGT), with lifestyle interventions on diet,(ii) on exercise,(iii) on diet combined exercise (duo-intervention) respectively in those with IGT, and (iv) screening alone. Independent age-specific models were simulated for25-,40-and60respectively. The reported outcomes were the remaining survival years, the quality-adjusted life years (QALYs) per diabetes subjects, societal costs per simulated subject and the comparisons between preventions and control over40years. Sensitivity analyses were performed based on variations of all assumptions.Results:1.(1) Many of the patients were elders (50%-53%), suffered with type2diabetes (84.9%-95.7%), but without complications (93.8%-98.5%), most of them were admitted in tertiary hospitals (59.1%-72.3%) and were under-covered by Special Outpatients Services (79.1%-90.1%) across years.(2) The hospitalization costs included fees for drugs (58.2%-61.5%), examinations (20.1%-23.5%), treatments (11.4%-12.4%), occupation of beds (5.1%-5.8%), others related items (0.6%-0.8%) and for the operations (0.3%-0.9%).(3) The higher costs were positively associated with age, out-of-pocket costs, hospital-levels and hospital stays.(4) Multi-variation analyses showed that aging, higher hospital-levels, longer stays, transfusion states, and patients’insurance registered in areas where has lower income, were served as the independent factors associated with higher costs for all type of diabetes patients. Additional risk factors such as retirement, multi-hospitalizations, and higher reimbursement rates for type2diabetes patients that were associated with higher hospitalization costs.2. Compared with control group, all simulated screening programs prolonged life expectancy at the initiation ages of25and40years, postponed the onset of diabetes and increased QALYs at every initiation age. Along with an assumption of six years intervention, prevention programs were associated with cost-saving compared with the control group, especially in the population aged25years. The cost savings were stable when baseline parameters were changed.Conclusions:1. More attentions should be paid to the hospitalization of middleraged patients. The fees for drugs account for the most part of costs for patients hospitalized with diabetes. The tertiary hospitals admitted most patients in Tianjin. Modifying the proportion of reimbursement rates might be an effective tool to reduce the high healthcare costs.2. The nature history of disease should be fully considered into models.3. One-off screening for diabetes and IGT, with appropriate lifestyle interventions for those with IGT could prolong the life time and retard the development of diabetes and its complications.4. One-off screening for diabetes and IGT, with appropriate lifestyle interventions for those with IGT are cost saving in China, especially in young adults.5. The change of incidence of diabetes complications might affect the implementation of diabetes prevention strategies, along with discount rates.