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      Direct medical cost of diabetes in rural China using electronic insurance claims data and diabetes management data

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          Abstract

          Aims/Introduction

          To evaluate the annual direct medical cost attributable to type 2 diabetes mellitus according to socioeconomic factors, medical conditions and complications categories.

          Materials and Methods

          We created uniquely detailed data from merging datasets of the local diabetes management system and the social security system in Tongxiang, China. We calculated the type 2 diabetes mellitus‐related total cost and out‐of‐pocket cost for inpatient admissions and outpatient visits, and compared the cost for patients with or without complications by different healthcare items.

          Results

          A total of 16,675 patients were eligible for analysis. The type 2 diabetes mellitus‐related cost accounted for 40.6% of the overall cost. The cost per patient was estimated to be a median of 1,067 Chinese Yuan, 7,114 Chinese Yuan and 969 Chinese Yuan for inpatient and outpatient cost, respectively. The median total cost for hospital‐based care was 3.69‐fold higher than that for primary care. The median cost of patients with complications was 3.46‐fold higher than that of those without complications. The median cost for a patient with only macrovascular, only microvascular or both macrovascular and microvascular complications were 3.13‐, 3.79‐ and 10.95‐fold higher than that of patients without complications. Pharmaceutical expenditure accounted for 51.8 and 79.7% of the total cost for patients with or without complications, respectively.

          Conclusions

          Although the type 2 diabetes mellitus‐related cost per patient was relatively low, it accounted for a great proportion of the overall cost. Complications obviously aggravated the economic burden of type 2 diabetes mellitus. Proper management and the prevention of diabetes and its complications are urgently required to curtail the economic burden.

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          Most cited references17

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          Revealing the cost of Type II diabetes in Europe.

          'The Cost of Diabetes in Europe - Type II study' is the first coordinated attempt to measure total healthcare costs of Type II (non-insulin-dependent) diabetes mellitus in Europe. The study evaluated more than 7000 patients with Type II diabetes in eight countries -- Belgium, France, Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom. A bottom-up, prevalence-based design was used, which optimised the collection of data at the national level while maintaining maximum international comparability. Effort was made to ensure consistency in terms of data specification, data collection tools and methods, sampling design, and the analysis and reporting of results. Results are reported for individual countries and in aggregate for the total study population. The total direct medical costs of Type II diabetes in the eight European countries was estimated at EUR 29 billion a year (1999 values). The estimated average yearly cost per patient was EUR 2834 a year. Of these costs, hospitalisations accounted for the greatest proportion (55%, range 30-65%) totalling EUR 15.9 billion for the eight countries. During the 6-month evaluation period, 13% of the Type II diabetic patients were hospitalised, with an average of 23 days in hospital projected annually. In contrast, drug costs for managing Type II diabetes were relatively low, with antidiabetic drugs and insulin accounting for only 7% of the total healthcare costs for Type II diabetes. Type II diabetes mellitus is a common disease and the prevalence is expected to increase considerably in the future, especially in developing countries. Current comprehensive economic data on the costs of diabetes are required for policy decisions to optimise resource allocation and to evaluate different approaches for disease management.
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            Medical costs associated with type 2 diabetes complications and comorbidities.

            To estimate the direct medical costs associated with type 2 diabetes, its complications, and its comorbidities among U.S. managed care patients. Data were from patient surveys, chart reviews, and health insurance claims for 7109 people with type 2 diabetes from 8 health plans participating in the Translating Research Into Action for Diabetes (TRIAD) study between 1999 and 2002. A generalized linear regression model was developed to estimate the association of patients' demographic characteristics, tobacco use status, treatments, related complications, and comorbidities with medical costs. The mean annualized direct medical cost was $2465 for a white man with type 2 diabetes who had been diagnosed fewer than 15 years earlier, was treated with oral medication or diet alone, and had no complications or comorbidities. We found annualized medical costs to be 10% to 50% higher for women and for patients whose diabetes had been diagnosed 15 or more years earlier, who used tobacco, who were being treated with insulin, or who had several other complications. Coronary heart disease, congestive heart failure, hemiplegia, and amputation were each associated with 70% to 150% higher costs. Costs were approximately 300% higher for end-stage renal disease treated with dialysis and approximately 500% higher for end-stage renal disease with kidney transplantation. Most medical costs incurred by patients with type 2 diabetes are related to complications and comorbidities. Our cost estimates can help when determining the most cost-effective interventions to prevent complications and comorbidities.
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              The Lifetime Cost of Diabetes and Its Implications for Diabetes Prevention

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                Author and article information

                Contributors
                minyu_cdc@126.com
                Journal
                J Diabetes Investig
                J Diabetes Investig
                10.1111/(ISSN)2040-1124
                JDI
                Journal of Diabetes Investigation
                John Wiley and Sons Inc. (Hoboken )
                2040-1116
                2040-1124
                17 August 2018
                March 2019
                : 10
                : 2 ( doiID: 10.1111/jdi.2019.10.issue-2 )
                : 531-538
                Affiliations
                [ 1 ] Department of NCDs Control and Prevention Zhejiang Provincial Center for Disease Control and Prevention Hangzhou China
                [ 2 ] Shorenstein Asia‐Pacific Research Center Stanford University Stanford California USA
                [ 3 ] Tongxiang Center for Disease Control and Prevention Tongxiang China
                [ 4 ] Stanford University Stanford California USA
                Author notes
                [*] [* ] Correspondence

                Min Yu

                Tel.: +86‐571‐8711‐5005

                Fax: +86‐571‐8711‐5005

                E‐mail address: minyu_cdc@ 123456126.com

                Author information
                http://orcid.org/0000-0003-4382-9153
                Article
                JDI12897
                10.1111/jdi.12897
                6400160
                29993198
                2438e160-cd8e-4f10-8003-01063d82b458
                © 2018 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 18 January 2018
                : 12 June 2018
                : 09 July 2018
                Page count
                Figures: 0, Tables: 4, Pages: 8, Words: 6910
                Funding
                Funded by: National Key Research and Development Program of CHINA ‘Precision Medical Research’
                Award ID: 2016YFC0900502
                Funded by: Medicine and Health Care in Zhejiang Province Science and Technology Platform Project
                Award ID: 2018RC025
                Award ID: 2017RC017
                Funded by: National Natural Science Foundation of China
                Award ID: 41401143
                Funded by: Public Technology Applications Research Program of Zhejiang Province
                Award ID: 2017C33090
                Categories
                Original Article
                Articles
                Epidemiology
                Custom metadata
                2.0
                jdi12897
                March 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.1 mode:remove_FC converted:05.03.2019

                complications,diabetes,direct medical cost
                complications, diabetes, direct medical cost

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