Samira Humaira
Accepted Abstracts: J Diabetes Metab
Aims: The economic burden resulting from diabetic neuropathy (DN) consumes a major portion of resources allocated for health-care services. This study was undertaken to assess the cost-effectiveness of medical intervention in patients with DN. Methods: Two hundred patients with DN, at least 1 year of follow-up, were purposively selected from Out-Patient Dept of BIRDEM, Bangladesh. Of them 100 were late in detection of DN (LDN) & 100 were detected early (EDN). The degree & extent of complications like cardiopathy, retinopathy, nephropathy & vasculopathy and direct, indirect & incremental cost of complications were calculated. Comparison was made between the groups. Results: A total of 200 patients were considered for an average of 365 days, amounting to 656 person-years of observation in total. In LDN group, 22% had Diabetic Peripheral Neuropathy (DPN), 17% had Diabetic Autonomic Neuropathy (DAN), 11% had Diabetic Proximal Neuropathy (DPXN) & 9% had Diabetic Focal Neuropathy (DFN). In EDN group, 16% had DPN and 7% had DAN. In LDN & EDN, 32% & 48% had one complication, 29% & 10% had two and 20% & 6% had more than two complications respectively. The most frequent complication was cardiopathy, which affected 33% patients in LDN & 27% in EDN. The average annual cost of care was US$ 26846 (direct US$ 17893 & indirect US$ 8953), with an average US$ 134 per patient. Among the average annual cost LDN consumed US$ 18918 (US$ 189 per patient) & EDN US$ 7928 (US$ 79 per patient). US$ 13473 (50%) of costs was attributable to Drugs for both groups of which US$ 10419 (77%) was for LDN & US$ 3054 (23%) for EDN, US$ 7653 (29%) to hospitalizations of which US$ 4914 (64%) for LDN & 2739 (36%) for EDN. In case of diagnostics & visits the corresponding values were US$ 1953 (55%) & 1580 (45%) and US$ 1631 (75%) & 556 (25%) for LDN & EDN respectively. The annual medical costs increased with the increased number of complications from US$ 1320 to 2296 to 3989 & to 6520 in LDN with one, two, three & more than three complications (other than DN) which is increasing at a rapid rate and US$ 917 to 1556 to 1872 & to 2073 in EDN respectively, increasing at a diminishing marginal rate. The regression equation showed that medical cost is significantly related to complications tested in both univariate (P<0.0001) & multiple linear regression analyses (R2 = 0.69; F-81.5, P < 0.0001). Conclusion: Proper management with regular screening substantially reduces the expenditure related to care & complications of patients with DN even in a developing country. Strategies aimed at early detection & prevention of DN will reduce medical costs in a substantial way
