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首页> 外文期刊>Journal of Clinical and Diagnostic Research >Evaluation of the Cost-Effectiveness ofDifferent Insulin Regimes during the Peri-Operative Period in Type-2 Diabetics in India
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Evaluation of the Cost-Effectiveness ofDifferent Insulin Regimes during the Peri-Operative Period in Type-2 Diabetics in India

机译：印度2型糖尿病患者围手术期不同胰岛素治疗方案的成本-效果评价

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Background and Objectives: Diabetes accounts for at least 10% of the total expenditure in many countries. Diabetics who undergo surgery are prone to adverse outcomes that can prolong their hospital stay and increase their health care expenditure. This prompted the present study to compare the cost-effectiveness of different insulin regimes during the perioperative period in type 2 diabetics.Study Design: This study was a multi-centric, prospective, single blind, randomised study. Two hundred eighty nine type 2 diabetes mellitus patients who underwent major elective surgeries were enrolled and randomly allocated to four groups A, B, C and D, receiving pre-mixed Regular/NPH(30:70), splitmixed Regular/NPH, split-mixed Glargine/Lispro and split-mixed Detemir/Aspart, respectively.Materials and Methods: Each group received multiple injections from the preoperative to the postoperative period until the patients were switched back to the same treatment regime which they received preoperatively. The starting dose of the insulin was 0.5 units per/kg body weight, which was then adjusted to maintain the average blood glucose level between 120-180mg/dl during the peri-operative period. The cost-effectiveness was calculatedand the interventions were compared on the basis of the amount which was needed to treat the patient. The average one day cost for all the regimes was calculated and the total cost was divided by the percentage of the success of the regime by applying an incremental cost-effectiveness formula. The Chi-square test was employed for analysis of the complications and one way ANOVA was used for the rest of the data. A probability value of less than 0.05 (p<0.05) was considered to be statistically significant.Results: There was a highly significant difference (p<0.001) in the mean costs of the regime A, B, C and D, respectively. The cost-effectiveness was done in a fashion of regime A vs. B and regime C vs. D. The incremental cost of the treatment for regime B was Rs. 7.21 and for regime D, it was Rs. 20.17 per added patient, with no peri-operative complications. However, the percentage of the incidence of the complications and the total cost was comparatively low with regime A.Conclusions: This study found the pre-mixed NPH/regular (30:70) regime to be a cost-effective therapy among the regimes which were compared, while the split-mixed (NPH) regime posed a greater financial burden on the patient in terms of the complications which occurred and the total cost of the treatment.
机译：背景和目标：在许多国家，糖尿病至少占总支出的10％。接受手术治疗的糖尿病患者容易出现不良后果，从而延长住院时间并增加医疗保健支出。这促使本研究比较了2型糖尿病患者围手术期不同胰岛素方案的成本效益。研究设计：本研究是一项多中心，前瞻性，单盲，随机研究。招募了289例接受了大手术的2型糖尿病患者，随机分配到A，B，C和D四组，分别接受常规/常规（NPH）（30:70），常规/常规（NPH）混合，材料和方法：每组从术前到术后接受多次注射，直到患者转回与术前相同的治疗方案。胰岛素的起始剂量为每公斤体重0.5个单位，然后在围手术期调整胰岛素的平均剂量以将平均血糖水平维持在120-180mg / dl之间。计算出成本效益，并根据治疗患者所需的数量对干预措施进行比较。计算所有方案的平均一天费用，并通过使用增量成本效益公式将总费用除以方案成功的百分比。卡方检验用于分析并发症，一种方法是将ANOVA用于其余数据。小于0.05（p <0.05）的概率值被认为具有统计学意义。结果：A，B，C和D方案的平均成本分别具有极高的差异（p <0.001）。以A方案对B方案和C方案对D方案的方式进行成本效益分析。B方案的治疗增量成本为Rs。 7.21，对于制度D，为卢比。每增加一名患者20.17，无围手术期并发症。但是，在方案A中，并发症的发生率和总费用相对较低。结论：这项研究发现，预混NPH /常规（30:70）方案是一种经济有效的方案，其中比较了混合混合（NPH）方案给患者带来的经济负担，包括发生的并发症和治疗的总费用。

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