The Net Value of Health Care for Patients With Type 2 Diabetes, 1997 to 2005
The Net Value of Health Care for Patients With Type 2 Diabetes, 1997 to 2005
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DOI：
10.7326/0003-4819-151-6-200909150-00003
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发表时间：
2009-09-15
影响因子：
39.2
通讯作者：
Newhouse, Joseph P.
中科院分区：
文献类型：
--
作者：
Eggleston, Karen N.;Shah, Nilay D.;Newhouse, Joseph P.
背景资料：增加卫生保健支出的净经济价值仍然不清楚，特别是对于慢性病。目的：评估2型糖尿病患者卫生保健的净价值。设计：观察性队列数据的经济分析。设置：马约诊所，罗切斯特，明尼苏达州，一个非营利的综合卫生保健提供系统。患者：613例2型糖尿病患者。测量：1997年至2005年经通货膨胀调整的年度卫生保健支出和健康状况的变化（健康状况定义为10年心血管风险），在整个观察期内保持年龄和糖尿病持续时间不变（"可改变的风险"），以及基于UKPDS（英国透视糖尿病研究）结果模型的所有糖尿病并发症的模拟结果。净价值估计为改善生存率和避免冠心病治疗支出的贴现货币价值减去每位患者年支出的增加。假设1个生命年价值20万美元，并考虑到可改变的心血管风险的变化，2型糖尿病患者医疗保健变化的净价值为每位患者10911美元（95%CI，-8480美元至33402美元），这是一个积极的美元价值，表明尽管支出增加，但医疗保健的价值有所改善。基于糖尿病并发症的第二种方法产生了每位患者6931美元的净价值（CI，-$186 901 to $211 980）。局限性：患者人群是同质的和小的，并且估计的宽CI与值的减少以及增加是相容的。结论：2型糖尿病患者健康状况改善的经济价值似乎超过或等于医疗保健支出的增加，这表明这些增加是值得的额外成本。然而，从统计学上不能排除社会的资金价值降低的可能性，而且有机会提高与糖尿病有关的医疗保健的价值。
Background: The net economic value of increased health care spending remains unclear, especially for chronic diseases.Objective: To assess the net value of health care for patients with type 2 diabetes.Design: Economic analysis of observational cohort data.Setting: Mayo Clinic, Rochester, Minnesota, a not-for-profit integrated health care delivery system.Patients: 613 patients with type 2 diabetes.Measurements: Changes in inflation-adjusted annual health care spending and in health status between 1997 and 2005 (with health status defined as 10-year cardiovascular risk), holding age and diabetes duration constant across the observation period ("modifiable risk"), and simulated outcomes for all diabetes complications based on the UKPDS (United Kingdom Perspective Diabetes Study) Outcomes Model. Net value was estimated as the present discounted monetary value of improved survival and avoided treatment spending for coronary heart disease minus the increase in annual spending per patient.Results: Assuming that 1 life-year is worth $200 000 and accounting for changes in modifiable cardiovascular risk, the net value of changes in health care for patients with type 2 diabetes was $10 911 per patient (95% CI, -$8480 to $33 402) between 1997 and 2005, a positive dollar value that suggests the value of health care has improved despite increased spending. A second approach based on diabetes complications yielded a net value of $6931 per patient (CI, -$186 901 to $211 980).Limitation: The patient population was homogeneous and small, and the wide CIs of the estimates are compatible with a decrease as well as an increase in value.Conclusion: The economic value of improvements in health status for patients with type 2 diabetes seems to exceed or equal increases in health care spending, suggesting that those increases were worth the extra cost. However, the possibility that society is getting less value for its money could not be statistically excluded, and there is opportunity to improve the value of diabetes-related health care.