The cost of managing severe hypoglycemic episodes in Type 2 diabetic patients

Introduction: Hypoglycemia is an acute complication of diabetes that increases morbidity, mortality and disease costs. We aim to estimate healthcare resource consumption and costs associated with severe hypoglycemia using the societal perspective. Methods: A cross-sectional, observational, nationwide, multicenter, hospital-based study was conducted in seven centers of Portuguese mainland with a 1-year enrolment period. Unit costs were extracted from official/public data sources. Patient-level data were used to quantify healthcare resource use related to emergency transportation, emergency-department care and hospitalization. Productivity loss was calculated based on the Human Capital Approach. Results: The study enrolled 238 Type-2 diabetic patients and the proportion of hypoglycemic episodes among all emergency events during the study period was 0.075% (95% CI: 0.067–0.083%). Mean patient age was 76 years and 57.6% were female. At time of the emergency department admission, 55% of patients were using insulin, 31.5% were being treated with secretagogues, 6.7% were on a combination of both, and 6.7% were on other oral antihyperglycemic agents. Estimated mean costs in the emergency department were: emergency transportation €33, medication €4, laboratory workup €56, other exams €72, physician and nurse time €30 and €13, respectively. Mean hospitalization cost was €1271. Indirect cost averaged €15. Overall cost per hypoglycemic episode averaged €1493 (standard deviation: €2962; range: €34–26,818). Patients treated with secretagogues had the highest rates of hospitalizations and mean costs. Conclusion: We conclude that severe hypoglycemic events represent a substantial cost for society and in particular for the hospitals of the National Health Service.

引言：低血糖症（Hypoglycemia）是糖尿病的急性并发症，可升高患者的发病率、死亡率与疾病治疗成本。本研究旨在从社会视角出发，评估与重度低血糖症相关的医疗资源消耗及成本。方法：本研究采用横断面、观察性、全国性多中心医院研究设计，在葡萄牙本土7家医疗中心开展，患者招募周期为1年。单位成本数据取自官方/公共数据源。研究采用患者水平数据，量化与急诊转运、急诊诊疗及住院治疗相关的医疗资源使用量。生产力损失基于人力资本法（Human Capital Approach）进行计算。结果：本研究共纳入238名2型糖尿病患者，研究期间所有急诊事件中低血糖发作的占比为0.075%（95%置信区间：0.067%~0.083%）。患者平均年龄为76岁，女性占比57.6%。在急诊入院时，55%的患者接受胰岛素治疗，31.5%采用促泌剂（secretagogues）治疗，6.7%联合使用上述两类药物，另有6.7%采用其他口服降糖药物治疗。急诊科室的平均成本构成如下：急诊转运费用33欧元、药物费用4欧元、实验室检查费用56欧元、其他检查费用72欧元、医师及护理人员工时费用分别为30欧元与13欧元。平均住院成本为1271欧元。间接成本平均为15欧元。每例低血糖发作的总成本平均为1493欧元（标准差：2962欧元；取值区间：34欧元~26818欧元）。接受促泌剂治疗的患者住院率及平均治疗成本均为最高。结论：本研究证实，重度低血糖事件会给社会带来沉重的经济负担，尤其对国家医疗服务体系（National Health Service）旗下医院而言。