Showing papers by "Ping Zhang published in 2010"

Cost-effectiveness of interventions to prevent and control diabetes mellitus: a systematic review.

Abstract: OBJECTIVE To synthesize the cost-effectiveness (CE) of interventions to prevent and control diabetes, its complications, and comorbidities. RESEARCH DESIGN AND METHODS We conducted a systematic review of literature on the CE of diabetes interventions recommended by the American Diabetes Association (ADA) and published between January 1985 and May 2008. We categorized the strength of evidence about the CE of an intervention as strong, supportive, or uncertain. CEs were classified as cost saving (more health benefit at a lower cost), very cost-effective (≤$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001 to $50,000 per LYG or QALY), marginally cost-effective ($50,001 to $100,000 per LYG or QALY), or not cost-effective (>$100,000 per LYG or QALY). The CE classification of an intervention was reported separately by country setting (U.S. or other developed countries) if CE varied by where the intervention was implemented. Costs were measured in 2007 U.S. dollars. RESULTS Fifty-six studies from 20 countries met the inclusion criteria. A large majority of the ADA recommended interventions are cost-effective. We found strong evidence to classify the following interventions as cost saving or very cost-effective: (I) Cost saving— 1 ) ACE inhibitor (ACEI) therapy for intensive hypertension control compared with standard hypertension control; 2 ) ACEI or angiotensin receptor blocker (ARB) therapy to prevent end-stage renal disease (ESRD) compared with no ACEI or ARB treatment; 3 ) early irbesartan therapy (at the microalbuminuria stage) to prevent ESRD compared with later treatment (at the macroalbuminuria stage); 4 ) comprehensive foot care to prevent ulcers compared with usual care; 5 ) multi-component interventions for diabetic risk factor control and early detection of complications compared with conventional insulin therapy for persons with type 1 diabetes; and 6 ) multi-component interventions for diabetic risk factor control and early detection of complications compared with standard glycemic control for persons with type 2 diabetes. (II) Very cost-effective— 1 ) intensive lifestyle interventions to prevent type 2 diabetes among persons with impaired glucose tolerance compared with standard lifestyle recommendations; 2 ) universal opportunistic screening for undiagnosed type 2 diabetes in African Americans between 45 and 54 years old; 3 ) intensive glycemic control as implemented in the UK Prospective Diabetes Study in persons with newly diagnosed type 2 diabetes compared with conventional glycemic control; 4 ) statin therapy for secondary prevention of cardiovascular disease compared with no statin therapy; 5 ) counseling and treatment for smoking cessation compared with no counseling and treatment; 6 ) annual screening for diabetic retinopathy and ensuing treatment in persons with type 1 diabetes compared with no screening; 7 ) annual screening for diabetic retinopathy and ensuing treatment in persons with type 2 diabetes compared with no screening; and 8 ) immediate vitrectomy to treat diabetic retinopathy compared with deferred vitrectomy. CONCLUSIONS Many interventions intended to prevent/control diabetes are cost saving or very cost-effective and supported by strong evidence. Policy makers should consider giving these interventions a higher priority.

Cost-Effectiveness of Bariatric Surgery for Severely Obese Adults With Diabetes

Abstract: OBJECTIVE To analyze the cost-effectiveness of bariatric surgery in severely obese (BMI ≥35 kg/m2) adults who have diabetes, using a validated diabetes cost-effectiveness model. RESEARCH DESIGN AND METHODS We expanded the Centers for Disease Control and Prevention–RTI Diabetes Cost-Effectiveness Model to incorporate bariatric surgery. In this simulation model, bariatric surgery may lead to diabetes remission and reductions in other risk factors, which then lead to fewer diabetes complications and increased quality of life (QoL). Surgery is also associated with perioperative mortality and subsequent complications, and patients in remission may relapse to diabetes. We separately estimate the costs, quality-adjusted life-years (QALYs), and cost-effectiveness of gastric bypass surgery relative to usual diabetes care and of gastric banding surgery relative to usual diabetes care. We examine the cost-effectiveness of each type of surgery for severely obese individuals who are newly diagnosed with diabetes and for severely obese individuals with established diabetes. RESULTS In all analyses, bariatric surgery increased QALYs and increased costs. Bypass surgery had cost-effectiveness ratios of $7,000/QALY and $12,000/QALY for severely obese patients with newly diagnosed and established diabetes, respectively. Banding surgery had cost-effectiveness ratios of $11,000/QALY and $13,000/QALY for the respective groups. In sensitivity analyses, the cost-effectiveness ratios were most affected by assumptions about the direct gain in QoL from BMI loss following surgery. CONCLUSIONS Our analysis indicates that gastric bypass and gastric banding are cost-effective methods of reducing mortality and diabetes complications in severely obese adults with diabetes.

Economic impact of Diabetes

Abstract: Summary Diabetes imposes a large economic burden on the national healthcare system. Healthcare expenditures on diabetes will account for 11.6% of the total healthcare expenditure in the world in 2010. About 95% of the countries covered in this report will spend 5% or more, and about 80% of the countries will spend between 5% and 13% of their total healthcare dollars on diabetes. Global health expenditures to prevent and treat diabetes and its complications will total at least US dollar (USD) 376 billion in 2010. By 2030, this number will exceed some USD490 billion. Expressed in International Dollars (ID), which correct for differences in purchasing power, the global expenditures on diabetes will be at least ID418 billion in 2010, and at least ID561 billion in 2030. An average of USD703 (ID878) per person wil l be spent on diabetes in 2010 globally. Expenditures spent on diabetes care are not evenly distributed across age and gender groups. More than three -quarters of the global expenditure in 2010 will be used for persons who are between 50 and 80 years of ag e. Also, more money is expected to be spent on diabetes care for women than for men. There is a large disparity in healthcare spending on diabetes between regions and countries.

Medical Expenditures Associated With Diabetes Acute Complications in Privately Insured U.S. Youth

Abstract: OBJECTIVE To estimate medical expenditures attributable to diabetes ketoacidosis (DKA) and severe hypoglycemia among privately insured insulin-treated U.S. youth with diabetes. RESEARCH DESIGN AND METHODS We analyzed the insurance claims of 7,556 youth, age ≤19 years, with insulin-treated diabetes. The youth were continuously enrolled in fee-for-service health plans, and claims were obtained from the 2007 U.S. MarketScan Commercial Claims and Encounter database. We used regression models to estimate total medical expenditures and their subcomponents: outpatient, inpatient, and drug expenditures. The excess expenditures associated with DKA and severe hypoglycemia were estimated as the difference between predicted medical expenditures for youth who did/did not experience either DKA or severe hypoglycemia. RESULTS For youth with and without DKA, respectively, predicted mean annual total medical expenditures were $14,236 and $8,398 (an excess of $5,837 for those with DKA). The excess was statistically greater for those with one or more episodes of DKA ($8,455) than among those with only one episode ($3,554). Predicted mean annual total medical expenditures were $12,850 and $8,970 for youth with and without severe hypoglycemia, respectively (an excess of $3,880 for those with severe hypoglycemia). The excess was greater among those with one or more episodes ($5,929) than among those with only one ($2,888). CONCLUSIONS Medical expenditures for potentially preventable DKA and severe hypoglycemia in U.S. youth with insulin-treated diabetes are substantial. Improving the quality of care for these youth to prevent the development of these two complications could avert substantial U.S. health care expenditures.

Impact of state mandatory insurance coverage on the use of diabetes preventive care

Abstract: 46 U.S. states and the District of Columbia have passed laws and regulations mandating that health insurance plans cover diabetes treatment and preventive care. Previous research on state mandates suggested that these policies had little impact, since many health plans already covered the benefits. Here, we analyze the contents of and model the effect of state mandates. We examined how state mandates impacted the likelihood of using three types of diabetes preventive care: annual eye exams, annual foot exams, and performing daily self-monitoring of blood glucose (SMBG). We collected information on diabetes benefits specified in state mandates and time the mandates were enacted. To assess impact, we used data that the Behavioral Risk Factor Surveillance System gathered between 1996 and 2000. 4,797 individuals with self-reported diabetes and covered by private insurance were included; 3,195 of these resided in the 16 states that passed state mandates between 1997 and 1999; 1,602 resided in the 8 states or the District of Columbia without state mandates by 2000. Multivariate logistic regression models (with state fixed effect, controlling for patient demographic characteristics and socio-economic status, state characteristics, and time trend) were used to model the association between passing state mandates and the usage of the forms of diabetes preventive care, both individually and collectively. All 16 states that passed mandates between 1997 and 1999 required coverage of diabetic monitors and strips, while 15 states required coverage of diabetes self management education. Only 1 state required coverage of periodic eye and foot exams. State mandates were positively associated with a 6.3 (P = 0.04) and a 5.8 (P = 0.03) percentage point increase in the probability of privately insured diabetic patient's performing SMBG and simultaneous receiving all three preventive care, respectively; state mandates were not significantly associated with receiving annual diabetic eye (0.05 percentage points decrease, P = 0.92) or foot exams (2.3 percentage points increase, P = 0.45). Effects of state mandates varied by preventive care type, with state mandates being associated with a small increase in SMBG. We found no evidence that state mandates were effective in increasing receipt of annual eye or foot exams. The small or non-significant effects might be attributed to small numbers of insured people not having the benefits prior to the mandates' passage. If state mandates' purpose is to provide improved benefits to many persons, policy makers should consider determining the number of people who might benefit prior to passing the mandate.

Cost-Effectiveness of Aspirin Use Among Persons With Newly Diagnosed Type 2 Diabetes

Abstract: OBJECTIVE To assess the long-term cost-effectiveness of aspirin use among adults aged ≥40 years with newly diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS We used a validated cost-effectiveness model of type 2 diabetes to assess the lifetime health and cost consequences of use or nonuse of aspirin. The model simulates the progression of diabetes and accompanying complications for a cohort of subjects with type 2 diabetes. The model predicts the outcomes of type 2 diabetes along five disease paths (nephropathy, neuropathy, retinopathy, coronary heart disease, and stroke) from the time of diagnosis until age 94 years or until death. RESULTS Over a lifetime, aspirin users gained 0.31 life-years (LY) or 0.19 quality-adjusted LYs (QALYs) over nonaspirin users, at an incremental cost of $1,700; the incremental cost-effectiveness ratio (ICER) of aspirin use was $5,428 per LY gained or $8,801 per QALY gained. In probabilistic sensitivity analyses, the ICER was CONCLUSIONS Regular use of aspirin among people with newly diagnosed diabetes is cost-effective.