To evaluate the expected life expectancy in patients with diabetes in Bulgaria and to compare it to the expected life expectancy of the non-diabetic population in the country. Methods It is a retrospective observational population study on individuals diagnosed with diabetes, compared to the non-diabetic population in Bulgaria for the period 2012-2015. Data from the national diabetes register and national statistical institute were used to construct lifetables with probability of survival with t-test and Chi Square test. Confounder analysis was done by age, sex, and type of diabetes. All-cause mortality and deaths in diabetic patients were analyzed. Kaplan-Meier survival curves were constructed for each age group and a log-rank analysis was conducted. Results Average life expectancy in the non-diabetic population, patients with Type 1 DM and with Type 2 DM is 74.8; 70.96 and 75.19 years, respectively. For 2012-2015 the mortality in the non-diabetic population remained constant and lower (average-1.48%) compared to type-1 DM (5.25%) and Type-2 (4.27%). Relative risk of death in diabetics was higher overall (12%), after the age of 70 before which the relative risk was higher for the non-diabetic population. This was observed as a trend in all analyzed years. Conclusion Patients with type 2 DM have a longer life-expectancy than patients with type-1 DM and overall Diabetics life expectancy equals that of the non-diabetic population, which could
The objective of this study was to evaluate the cost of hospitalizations due to micro-and macrovascular complications in an observed cohort of 433 patients with diabetes. A six-month combined retrospective and prospective observational study was performed. The patients were separated into two groups depending on the type of diabetes and further into subgroups depending on the reason for hospitalization. The total costs for each subgroup were calculated and compared to the total costs of treatment for the observed period. In the type 2 diabetes group (n D 255), there were 128 people with microvascular complications and 215 ones with macrovascular complications, whereas in the type 1 diabetes group, there were only 70 people out of 178 with microvascular complications and 72 ones with macrovascular complications. The total cost of hospitalizations in the type 2 diabetes group was 34 469.76 EUR with the following reported reasons for hospitalizations: poor control of diabetes (45%), microvascular complications (23%) and macrovascular complications (31%). In the type 1 diabetes group, the total hospitalizations cost was equal to 15 319.33 EUR with the following split: 59% due to poor control of diabetes, 22% due to microvascular complications and 19% due to macrovascular complications. Thus, type 2 diabetes is more costly than type 1 when hospitalizations occur. Type 2 diabetes is associated with higher cost of macrovascular complications than of microvascular ones probably due to high hypertension prevalence. Costs are paid by the health insurance fund and the differences need to be systematically revealed.
Objectives: To analyze strategies of management of patients with diabetic polyneuropathy (DPN) considering the prevalence of DPN and diabetic foot (DF) in Russia. MethOds: The analysis was based on epidemiologic data on DPN and DF, and placebo controlled trials (ALADIN III for alpha-lipoic acid, and D. Ziegler study for Actovegin). Strategies with alpha-lipoic acid (1st group) and with Actovegin (2st group) were compared. In both cases, a 160-day course consisted of 20 days of parenteral injection in hospital, and 140 days of outpatient oral administration. Clinical outcomes and health care system costs were analyzed; cost-effectiveness ratio (CER) was calculated. The share of patients without DF was the main measure of effectiveness. Costs of the drugs, and hospital and outpatient treatment for budget holder were evaluated in two equal-sized groups. During the sensitivity analysis, clinical outcomes (risk of DF) were modeled with increment of 100 persons from 100 to 1000 patients. Results: The cohort of 10 000 patients with type 2 diabetes mellitus contained 6100 patients with DPN including 3700 patients with medium or severe stages. 2100 persons were in risk group for DF, including 1100 patients with high risk. 410 and 330 patients had DF in alpha-lipoic acid group and Actovegin group, respectively. The number of amputations in these groups was 70 and 56. The costs of 160-day treatment was 64,929.73 RUB in the 1st group, and 64,355.73 RUB in the 2nd group. The share of patients without DF was 70.02% and 62.7%. CER were 103,556.19 in alpha-lipoic acid group, and 91,910.50 in Actovegin group. The sensitivity analysis confirmed the advantage of Actovegin administration cOnclusiOns: The study showed clinical and pharmacoeconomic advantages of Actovegin administration in patients with DPN and DF. This strategy has more preferable CER and lower costs for public health care system.
The study investigates the quality of diabetes control and its economic implications in Bulgaria for the years 2012-2016. It is a retrospective study of the national diabetes register. Patients were categorized according to type of diabetes, gender, newly diagnosed cases per year, bodymass index (BMI) and achieved disease control. The relative risks for reducing the diabetesrelated complications achieved through a 1% reduction of HbA1c were taken from literature data, and macrocosting was used to calculate the saved cost for diabetes complications. The new cases of type 1 diabetes decreased (10% lower in 2016 than in 2012) but the number of new cases with type 2 diabetes increased (12%). In 2012, the average percentage of glycosylated hemoglobin in the second recording at the end of the year was 7.59% (SD 1.85), whereas the second recording of values for 2016 revealed an average value of 7.3% (SD 1.32). The mean yearly reduction in 2012 was 0.05% (SD 1.1) with a slow increase to 0.07% (SD 0.46) in 2016. The absolute risk reduction for all diabetes-related complications was 20.6. The total prevented costs for all complications in the entire population were 20 million BGN. The results for the period 2012-2016 showed improved control of diabetes. The proportion of patients who achieved control increased over the period, reaching over 40% of the afflicted population. The achieved adequate control led to a reduced risk of developing diabetes-related complications, thereby saving costs of 20 million BGN associated with them, and decreasing the burden on the healthcare system.
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