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Cost-effectiveness analysis of medical Cost-effectiveness analysis of medical intervention in patients with early intervention in patients with early
detection of diabetic complications in detection of diabetic complications in a tertiary care hospital in Bangladesha tertiary care hospital in Bangladesh
Samira Humaira HabibSamira Humaira Habib
Health Economics Unit, Diabetic Association of Health Economics Unit, Diabetic Association of Bangladesh (BADAS), Dhaka, BangladeshBangladesh (BADAS), Dhaka, Bangladesh
e-mail: e-mail: [email protected]@yahoo.com; ; [email protected]@dab-bd.orgMobile: 00 88 01552377954Mobile: 00 88 01552377954
IntroductionIntroduction
Diabetes mellitus - most serious and Diabetes mellitus - most serious and prevalent chronic diseaseprevalent chronic disease
Leads the development of certain acute Leads the development of certain acute syndromes like chronic medical syndromes like chronic medical conditionsconditions
The economic burden resulting from The economic burden resulting from
diabetes related complication contributes diabetes related complication contributes a major portion in the allocation of a major portion in the allocation of health-care resourceshealth-care resources
IntroductionIntroduction
Cost-effectiveness studies on various intervention in type 2 diabetes and its complications
- good number in developed countries- almost absent in developing
countries
But it should be conducted in different socioeconomic settings
Aims and ObjectivesAims and Objectives
To investigate whether early detection and To investigate whether early detection and management management
-can substantially reduce complications, -can substantially reduce complications,
-can substantially reduce the cost of -can substantially reduce the cost of complications, complications,
-can increase survival and the interval -can increase survival and the interval without complications, without complications,
To observe whether cost effectiveness ratio will be To observe whether cost effectiveness ratio will be able to compare favorably with many accepted able to compare favorably with many accepted healthcare programmes healthcare programmes
Subjects and Methods Study Design: Study Design: Cross-sectional study and Cross-sectional study and
retrospective in nature.retrospective in nature. Source of Data: Source of Data: Primary data was taken Primary data was taken
through a self administrated pre-set through a self administrated pre-set questionnaire. questionnaire.
Sample size: Sample size: 1000 patients with Type 2 1000 patients with Type 2 Diabetes, with at least 3 year of follow-up. 500 Diabetes, with at least 3 year of follow-up. 500 were Late in detection and 500 were early were Late in detection and 500 were early detecteddetected
Sampling: Sampling: Purposively selected from BIRDEMPurposively selected from BIRDEM
Inclusion Criteria
Type 2 Diabetic subjects with minimum 1 years of duration and have develop complication already
Exclusion Criteria:
Pregnancy, Any other illness, Mental disorders, Newly diagnosed cases
Subjects and Methods
Material and MethodsMaterial and Methods The variables are The variables are
-the degree & extent of complications -the degree & extent of complications -treatment outcome-treatment outcome-clinical effectiveness -clinical effectiveness -direct, indirect & incremental cost -direct, indirect & incremental cost
Comparison was made between the groups. Comparison was made between the groups. Cost included Cost included
-drugs -drugs -hospitalizations -hospitalizations -diagnostics & -diagnostics & -visits -visits
Data were analyzed in SPSS methodsData were analyzed in SPSS methods
Variables Description Percentage Distribution
Age 40-5051-60> 61
57.240.12.7
Education Literate-below SSCSSC – HSCGraduate and above
95.73.70.5
Family Members
1-45-8> 8
43.952.93.2
Socioeconomic status
Status 1 (<5000)Status 2 (5001-10000)Status 3 (10001-20000)Status 4 (20001-40000)Status 5 (40001-80000)Status 6 (>80000)
10.20.519.336.420.912.8
Occupation House wifeServicesOthers
61.010.728.3
Table 1: % Dist. of the study subjects according to the Demographic Variables
Table 2: Clinical findings between the groups
Clinical Parameters
Group
Early detected Late detected P Value
FBS (mmol/l) 4.78±0.38 9.36±0.40 0.004
T Chol (mmol/dl)
104.20±35.50 206.50±42.60 0.006
HbA1c (%) 5.70±0.38%, 9.80±0.50% 0.004
TG (mmol/dl) 155.67±94.84 163.76±99.46 0.0001
Serum Creatinine (mmol/l)
4.90±1.17 0.89±0.03 0.004
HDL (mmol/dl) 11.57±1.25 16.16±1.61 0.091
LDL (mmol/dl) 131.98±39.88 123.05±32.05 0.0001
SBP (mm/ Hg) 112.7321.29 212.7741.40 0.0001
DBP (mm/ Hg) 72.5614.93 109.8020.00 0.0001
Table 3: Anthropometrics parameters of the study subjects
Anthropometrics parameters
Early detected Late detected P Value
BMI 21.244.38 29.713.47 0.0001
WHR 0.89540.006 0.88860.006 0.453
19% patients in Late detected (LD) & 36% in 19% patients in Late detected (LD) & 36% in Early detected (ED) were free of diabetic Early detected (ED) were free of diabetic complications. complications.
In LD, 32% had one complication, 29% had two In LD, 32% had one complication, 29% had two & 20% had more than two complications. & 20% had more than two complications.
On the other hand, in ED the corresponding On the other hand, in ED the corresponding values were 48%, 10% & 6% respectively. values were 48%, 10% & 6% respectively.
The most frequent complication was cardiopathy The most frequent complication was cardiopathy
Direct and Indirect Cost among the patients
61%
39%
Direct Cost
Indirect Cost
Figure 1: Total cost distribution among the study groups
Table-4: Cost Components among the study groups
Group/ ItemsGroup/ Items LD ED Total (US$)
Cost of the Patients 19837 8117 27954
Average/patients 198 81 140
Table 5: Cost Distribution
Total % LD % ED %
Drug 13473 48 10817 80 2656 20
Hospital 8739 31 5211 60 3528 40
Diagnostic 3555 13 2136 60 1419 40
Visits 2187 8 1673 76 514 24
Grand Total 27954 100 19837 71 8117 29
Table 6: Cost and Complications
Complications Standardized Coefficients
t Sig.
Std. Error Beta
(Constant) 15285.404 4.681 0.000
Cardiopathy 12645.198 -.069 3.930 0.004
Retinopathy 14226.417 .009 3.10 7 0.001
Neuropathy 6443.232 -.072 8.886 0.004
Vasculopathy 15273.074 .029 .952 0.001
a Dependent Variable: COST
Table 7: Multiple Linear Regression taking cost as a dependent variable
Standardized Coefficients
t Sig.
Std. Error Beta
(Constant) 268538.58 1.051 .003
Serum glucose (mmol/l) 53039.465 .098 1.199 .002
S_Creatinine (mmol/l) 22682.870 .056 .223 .003
HbA1C (%) 39242.222 .100 .501 .003
Triglyceride (mg/dl) 283.623 .026 .268 .002
Total cholesterol (mg/dl) 482.815 .014 .149 .001
LDL-Chol (mg/dl) 586.022 .025 .307 .003
HDL- Chol (mg/dl) 1379.778 .062 .767 .744
a Dependent Variable: Cost
Interesting findings of the Study Interesting findings of the Study SubjectsSubjects
One, two & more than two One, two & more than two complicationscomplications
Late detected Diabetic GroupLate detected Diabetic Group- US$ 1320 to 2296 & to 3989 - US$ 1320 to 2296 & to 3989
- increasing at a rapid rate- increasing at a rapid rate
Early detected Diabetic GroupEarly detected Diabetic Group- US$ 917 to 1556 & to 2372 - US$ 917 to 1556 & to 2372
- increasing at a diminishing marginal rate- increasing at a diminishing marginal rate
Conclusion:Conclusion:
Proper management with regular screening substantially Proper management with regular screening substantially reduces the expenditure related to care reduces the expenditure related to care
Strategies aimed at preventing diabetes & early detection Strategies aimed at preventing diabetes & early detection of the onset of the onset
Timely management both clinically astute and cost Timely management both clinically astute and cost effective. effective.
Increase survival and the interval without complications Increase survival and the interval without complications
Cost effectiveness ratio will be able to compare favorably Cost effectiveness ratio will be able to compare favorably with many accepted healthcare programmes. with many accepted healthcare programmes.
AcknowledgementAcknowledgementI am highly grateful toI am highly grateful to
Prof Hajera Mahtab,Prof Hajera Mahtab, my Supervisor & Professor, for well my Supervisor & Professor, for well designed guidance, constructive criticism, intellectual input and designed guidance, constructive criticism, intellectual input and opening me to the door of wonderful field of Health Economics.opening me to the door of wonderful field of Health Economics.
Diabetic Association of Bangladesh, Dhaka Diabetic Association of Bangladesh, Dhaka
To all my Coauthors for their continuous help and for sharing pain and pleasure through a lovely companionship
Novo Nordisk Pharma Pvt Ltd for their cooperation
