Type 2 diabetes mellitus in Bangladesh: a prevalence based cost-of-illness study
Type 2 diabetes mellitus in Bangladesh: a prevalence based cost-of-illness study
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DOI：
10.1186/s12913-019-4440-3
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发表时间：
2019-08-27
影响因子：
2.8
通讯作者：
Billah, Baki
中科院分区：
文献类型：
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作者：
Afroz, Atsana;Alam, Khurshid;Billah, Baki
背景：在包括孟加拉国在内的许多低收入和中低收入国家，2型糖尿病的经济负担尚未得到充分调查。这项研究的目的是估计孟加拉国2型糖尿病的疾病成本，并寻找其影响因素。方法：2017年在孟加拉国北部和中部地区的6家糖尿病医院招募1253名2型糖尿病患者，提供初级到三级医疗服务。采用结构化问卷进行面对面访谈，收集非临床资料。患者的医疗记录被审查以获得临床数据，医院记录被审查以获得住院数据。费用是从患者的角度使用自下而上的方法计算的。计算每个患者的直接成本和每个患者及其护理人员的间接成本。直接成本计算采用微观成本法，间接成本计算采用人力资本法。结果：受试者中54%为男性。平均(+/-SD)年龄55.1±12.5岁，糖尿病病程10.7±7.7年。平均每年每名患者的费用为864.7美元。药品费用占直接费用的60.7%，其次是住院费用，占27.7%。有住院治疗的患者的平均年费用是没有住院患者的4.2倍。女性、使用胰岛素、糖尿病病程较长、糖尿病并发症与人均年费用显著相关。结论：孟加拉国的糖尿病护理费用相当高，主要由药品和住院费用驱动。为了预防并发症和并发症，迫切需要通过积极的生活方式改变来优化糖尿病管理，这反过来将降低成本。
Background: The economic burden of type 2 diabetes has not been adequately investigated in many low- and lower middle-income countries, including Bangladesh. The aim of this study was to estimate the cost-of-illness of type 2 diabetes and to find its determinants in Bangladesh.Methods: A cross-sectional study was conducted in 2017 to recruit 1253 participants with type 2 diabetes from six diabetes hospitals, providing primary to tertiary health care services, located in the northern and central regions of Bangladesh. A structured questionnaire was used for face-to-face interviewing to collect non-clinical data. Patients' medical records were reviewed for clinical data and hospital records were reviewed for hospitalisation data. Cost was calculated from the patient's perspective using a bottom-up methodology. The direct costs for each patient and indirect costs for each patient and their attendants were calculated. The micro-costing approach was used to calculate direct cost and the human capital approach was used to calculate indirect cost. Median regression analysis was performed to identify the determinants of average annual cost.Results: Among the participants, 54% were male. The mean (+/- SD) age was 55.1 +/- 12.5 years and duration of diabetes was 10.7 +/- 7.7 years. The average annual cost was US$864.7 per patient. Medicine cost accounted for 60.7% of the direct cost followed by a hospitalisation cost of 27.7%. The average annual cost for patients with hospitalisation was 4.2 times higher compared to those without hospitalisation. Being females, use of insulin, longer duration of diabetes, and presence of diabetes complications were significantly related to the average annual cost per patient.Conclusions: The cost of diabetes care is considerably high in Bangladesh, and it is primarily driven by the medicine and hospitalisation costs. Optimisation of diabetes management by positive lifestyle changes is urgently required for prevention of comorbidities and complications, which in turn will reduce the cost.