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目的评估糖尿病患者强化降糖管理与标准治疗的长期成本效用。方法应用糖尿病计算机模拟模型(CORE糖尿病模型)来预测长期(30年)的健康及卫生经济学情况。模拟的数据来自社区-医院一体化管理的300例2型糖尿病患者,随机分为强化治疗组(n=145)和标准治疗组(n=155),为期54个月。结果较标准治疗组,强化治疗组的视网膜病变、肾脏病变和心血管病变的累积发生率明显减少;背景期视网膜病变、终末期肾病、足溃疡、充血性心力衰竭和心肌梗死事件的发生分别降低4.299%、0.814%、2.357%、2.594%和4.003%。强化治疗组的期望寿命显著增加了(0.476±0.251)年,而与此相关的质量调整生命年(QALYs)增加了0.418±0.173,直接医疗成本增加5940元。而增量成本效果比增加14217元。结论 2型糖尿病患者强化管理治疗能显著降低糖尿病并发症的发生率,改善长期预后;强化管理治疗与期望寿命和质量调整生命年的改善有关。
Objective To assess the long-term cost-effectiveness of intensive glycemic management and standard treatment in patients with diabetes. Methods Diabetes computer modeling (CORE diabetes model) was used to predict long-term (30-year) health and health economics. Simulated data from 300 community-hospital managed type 2 diabetes patients were randomly assigned to intensive treatment (n = 145) and standard treatment (n = 155) for 54 months. Results Compared with the standard treatment group, the cumulative incidence of retinopathy, nephropathy and cardiovascular disease was significantly reduced in the intensive treatment group. The incidence of retinopathy of retina, end-stage renal disease, foot ulcer, congestive heart failure and myocardial infarction were decreased 4.299%, 0.814%, 2.357%, 2.594% and 4.003%. The life expectancy of the intensive treatment group increased significantly (0.476 ± 0.251) years, while the related QALYs increased by 0.418 ± 0.173 and the direct medical costs increased by 5940 yuan. Incremental cost-effective than the increase of 14,217 yuan. Conclusion Intensive management of patients with type 2 diabetes can significantly reduce the incidence of diabetic complications and improve long-term prognosis; intensive management and treatment of life expectancy and quality-adjusted life years of improvement.