The Health Economic Evaluation Of "Co-management Of Doctors Of Three Kinds" Of Diabetes Patients In Xiamen

Objective:To examine the short-term effects of "co-management of doctors of three kinds" of diabetes patients in Xiamen and make short-term cost-effectiveness and cost-benefit analysis.And use Markov model to simulate the long-term effects of"co-management of doctors of three kinds" of diabetes patients and make economic evaluation.Materials and Methods:1?A cross-sectional survey was performed among community residents with T2DM in Xiamen during June to August on 2016.Patients in the control group were carried usual management,and the intervention group was carried "co-management ofdoctors of three kinds".Both group was included 400 diabetes patients and were managed for 1 year.Questionnaires were designed to collect patients' information,involving sociodemographic variables,illness,treatment,knowledge of diabetes,diabetes self-management,quality of life and economic burden of disease.And the cost of intervention was measured.The economic burden of disease was divided into direct cost,indirect cost and intangible cost.The cost of intervention was included the operation cost of community health service center,the subsidy of management and inspection of diabetes patients,and other cost associated with "doctors of three kinds".The effectiveness indexes were included biochemical indicators,hierarchical medical indicators,knowledge of diabetes,diabetes self-management,quality of life.The benefit was measured by the reduction of economic burden in "co-management of doctors of three kinds".2.Based on the big data of healthcare in Xiamen,the follow-up data during 2015 to 2016 of community residents with T2DM were obtained in this study.The patients were further divided into intervention group and control group according whether or not participate "co-management of doctors of three kinds".Finally,24085 patients were included in this study,and among them 4087 patients were in intervention group and 19998 patients in control group.Desciptive analysis was used to describe the baseline of patients;evaluated the change of diabetes complications during the follow up;constructed Markov diabetes model;defined the parameters and transition probability in the model;use Markov model to simulate the change of diabetes complications and death after 10 years;make economic evaluation based on long-term effects and cost.Results:1?the economic evaluation of short-term intervention of "co-management of doctors of three kinds" of diabetes patients1)No statistically difference has been found between intervention group and control group on sociodemographic variables,baseline biochemical indicators and diseases.2)After one year's management,intervention group versus control group:?biochemical indicators:the control rate of hemoglobin Alc(HbAlc)levels and 2h postprandial plasma glucose was improved;?hierarchical medical indicators:the rate of community first diagnosis and two-way referral was improved;? the knowledge of diabetes and the ability of self-management was improved.3)Per capita economic burden of disease in intervention group was 5569 yuan a year,which was 1412 yuan less than the control group.4)Increment cost-effectiveness:To increase 1 percent of the control rate of HbAlc,the cost of intervention is 15.04 yuan per patients per year;to increase 1 percent of the control rate of 2h postprandial plasma glucose,the cost of intervention is 36.47 yuan per patients per year;to increase 1 percent of the rate of community first diagnosis and two-way referral,the cost of intervention is 51.57 yuan and 16.73 yuan per patients per year;to increase 1 percent of the control rate of the knowledge of diabetes and the ability of self-management,the cost of intervention is 40.00 yuan and 47.34 yuan per patients per year.5)Increment cost-benefit:The ratio of increment cost-benefit was 2.78,which indicates that the "co-management of doctors of three kinds" of diabetes patients is more beneficial2.the economic evaluation of long-term intervention of "co-management of doctors of three kinds" of diabetes patients1)After one year's management,the increased prevalence of complications is 3.01%vs.5.49%in intervention group vs.control group.The changed prevalence of complications was lower in intervention group.2)Using Markov model,this study simulated the final number of patients who has complication of not in a defining cohort which starts with 100000 T2DM patients after 10 year's management.And the result shows that:the increased number of T2DM patients with complications in intervention group was less than control group(22203 vs.33990);the number of patients death from diabetes in intervention group was less than control group(63 vs.73).3)Using the changed number of T2DM patients with complication as the effectiveness index,Increment cost-effectiveness shows that:the increased cost is 4446.285 million in the intervention group;to avoid one T2DM patient with conplications,the cost of intervention is 37700 yuan.Conclusion:Compared with routine management,short-term intervention of"co-management of doctors of three kinds" can significantly improve T2DM4 patients'glucose control,knowledge of diabetes,self-management,community first diagnosis and two-way referral;can significantly decrease the economic burden of disease;and shows better cost-effectiveness and cost-benefit.Moreover,long-term intervention of"co-management of doctors of three kinds" can significantly decrease the number of T2DM patients with complications and the number of T2DM patients death from diabetes.The "co-management of doctors of three kinds" of diabetes patients in Xiamen has better cost-effectiveness and cost-bene fit and positively meaningful for China's reference in diabetes management.