| Objectives To realize the current status of direct medical costs and exploring the influencing factors of quality of life(QOL)in diabetic patients.To evaluate the economic significance of health interventions for relieving the economic burden of diabetes by building a diabetic Markov model.To further improve the QOL of diabetic patients,and provide reference basis for improving the intervention strategy of diabetes.Methods Literatures were searched in China National Knowledge Infrastructure(CNKI),Wanfang database,Weipu database and Pubmed.Decided the model circle period and collected the data of direct medical costs,health utility and transition possibility based on the review of literature.Calculated the health economic data based on cost-effectiveness analysis,Markov cohort analysis and Monte-Carlo analysis.Explored the impact of important parameters on the results and the stability of the diabetic model by sensitive analysis.EQ-5D-5L was adopted to measure the QOL and analyze its influencing factors.Results(1)The direct medical costs of diabetes showed a gradually increase,and the median cost was 6406.18 Chinese Yuan(CNY);S function was used to simulate the trend of direct medical costs: direct medical costs = exp(129.911-243310.132/).The intervention cost was collected from the study of the diabetic comprehensive prevention and control strategy in Shanghai.Effectiveness parameters were collected from the study on the health of diabetes at home and abroad.Transition possibility parameters were collected from the study of diabetic intervention project in Daqing.(2)The cumulative cost and effectiveness of intervention group(461822.79 CNY and 17.09QALY)were higher than control group(445273.93 CNY and 11.91QALY),and the incremental cost was 3197.44 CNY,which meant the cost of getting a QALY for intervention group was 3197.44 CNY compared with control group.(3)The lines were longer corresponding to the cost discount rate and the utility discount rate in Tornado Diagram,which meant the discount rates were the sensitive parameter.(4)The QOL of diabetic patients was poor,and pain/discomfort was the major health problem of diabetic patients(74.4%),VAS score was(71.94±18.24).Age,culture degree,psychological health,relationship,exercise,complications and side-effects were the influencing factors of diabetic patients.Conclusion(1)Determining Markov state and circle period were the basis of modeling,and obtaining parameters was the key to modeling.(2)Behavioral intervention was a cost-effective strategy with low cost and high outcomes.(3)Reasonable discount rate was particularly important to improve the scientificalness of the results in intervention study.(4)The health effectiveness of psychological counseling,health education and exercise plan intervention would better than single clinical treatment,which verify the effectiveness and importance of interventions to improve the QOL in patients with diabetic diabetes. |
