临床医学]治疗糖尿病成本研究.ppt

CODIC-中国大城市治疗 2型糖尿病及其并发症的成本研究 CODIC - Cost of Treating Type2 Diabetes 严格控制血糖可降低视网膜病、肾病、神经病的发生率 Better hyperglycemia control reduces retinopathy, nephropathy and possible neuropathy 控制高血压可降低中风、心衰、失明、微血管并发症和与糖尿病相关 的死亡的发生率 Controlling hypertension reduces strokes, heart failure, visual loss, microvasular complications and Diabetes-related deaths. MESSAGE: 2型糖尿病治疗管理应以降低糖尿病并发症发病率和严格控制血糖为 目标 Insulin resistance management should be aimed at optimal control at blood glucose and hence reduction of co-morbidities 主要内容 Contents 糖尿病流行病学 Epidemiology of diabetes mellitus CODIC方法学 CODIC methodology CODIC项目糖尿病人口学特征 Demographics of diabetic patients in CODIC 2型糖尿病病人疾病负担 Disease burden of patients with type 2 diabetes CODIC方法学 CODIC methodology 中国有11个省会城市参与了CODIC项目： CODIC covers 11 provincial capital Chinese cities: 北京、上海、广州、成都、武汉、沈阳、南京、济南、西安、重庆、杭州 Beijing, Shanghai, Guangzhou, Chengdu, Wuhan, Shenyang, Nanjing, Jinan, Xian, Chongqing, Hangzhou 采访了200名内分泌专家 Interviews of 200 endocrinologists 4000名糖尿病病人填写了调查问卷 4000 Diabetes Patient Forms completed 进一步采访了806名有并发症的2型糖尿病病人和300名无并发 症的糖尿病病人 Further 806 Type2 diabetes patients with complications and 300 diabetic patients without complications interviewed 2型糖尿病患者抽样调查问卷 Type2 Diabetes patient sample questionnaire 所有的费用的数据来自对病人的访问 All Cost data derived from Patient interviews 请问您是否患有2型糖尿病的并发症? * Do you suffer from diabetic complications due to T2DM ?* 您患有下列哪些并发症和或在过去的一年中接受过哪些治疗？ Which of these complications or procedures you are currently suffering from/have you undergone in the last year ? (complications as listed in next slide) 在过去的一年中您由于2型糖尿病及其并发症住过几次医院？ History of any hospitalisation due to T2DM or its complications during the last year ? 在过去的一年中您由于2型糖尿病及其并发症您看过几次门诊？ Number of medical consultations due to T2DM or its complications in the last year ? * only patients with complications DUE TO T2DM are included in the study 并发症 - 调查病人的样本量 Complications Patient Survey Sample Size DM Complication selection based on ISIS PhV Therapy Monitor prevalence rate 主要内容 Contents 糖尿病流行病学 Epidemiology of diabetes mellitus CODIC方法学 CODIC methodology CODIC项目糖尿病人口学特征 Demographics of diabetic patients in CODIC 2型糖尿病病人疾病负担 Disease burden of patients with type 2 diabetes 2型糖尿病病人的人口统计学特征 Type2 Diabetes patient demographics 病人的平均年龄为58岁 Patient Mean age is 58 years old. 糖尿病平均病程约为6年 Mean average duration of diabetes is about 6 years. 2型糖尿病的平均体重指数（BMI）为24kg/m2 Mean average BMI of T2DM patients is 24 kg/m2 WHO提出亚洲人的体重指数正常范围为18.5-23 kg/m2 WHO range for acceptable, normal, or optimum body-mass index (BMI) for Asian populations should be narrowed to 185-23 kg/m2, Message : 2型糖尿病人群有肥胖倾向 Type2 Diabetes population has a propensity for obesity. Lancet (2002) Vol 360 血糖控制 Glycaemic control 32%的病人血糖控制差-HbAIc7.5% 32% of patients have poor glycemic control (defined as HbAIc 7.5) 只有37%口服降糖药治疗病人和47%胰岛素治疗的病人得到很好的血糖控制 Only 37% of patients on OHA and 47% on insulin had “good” glycemic control 采用饮食和运动治疗的病人平均HbAIc为7.23%, 口服降糖药治疗的病人为 7.43% ，胰岛素治疗的病人为6.25% Patients treated with diet and exercise had a mean HbAIc of 7.23%, compared to patients on OHA with 7.43% and patients on insulin with 6.25% Message: 大多数病例表现出渐进性细胞功能衰退、口服降糖药治疗失败而不能维 持血糖控制 Most likely reflects the progressive deterioration of beta cell function and the failure of current OHA therapies to provide sustained glycaemic control ISIS Diabetic Therapy Monitor PhVI 2002 American Diabetic Association guidelines 大城市2型糖尿病病人的大血管并发症的患病率 Prevalence of T2DM complications (macro-vascular) in urban cities 并发症（Complications）患病率（每千例有并发症糖尿病患者中的 例数） Prevalence (No. in 1000 complicated diabetic patients) TIA148 心绞痛（Angina）109 卒中（Stroke）77 CHF24 AMI23 PTCA5 CABG2 ISIS Diabetic Therapy Monitor PhVI 2002 大城市2型糖尿病病人的微血管并发症的患病率 Prevalence of T2DM complications (micro-vascular) in urban cities 并发症(Complications)患病率（每千例有并发症糖尿病患 者中的例数） Prevalence (No. in 1000 complicated diabetic patients) 外周神经病变（Peripheral Neuropathy) 212 光凝治疗(Photocoagulation)202 肾衰(Renal Failure)70 足溃疡(Foot Ulcer)30 失明(Blindness)15 透析(Dialysis)4 截肢(Amputation)3 ISIS Diabetic Therapy Monitor PhVI 2002 大城市2型糖尿病病人的微血管并发症的患病率 Prevalence of T2DM complications (micro-vascular) in urban cities 0.5% 5.0% 2.5% 32.9% 0.6% 9.5% 0.0%5.0%10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 截肢 (Amputation) 足溃疡 (Foot Ulcer) 失明 (Blindness) 光凝固术 (Photocoagulation) 透析 (Dialysis) 肾衰 (Renal Failure) 大城市2型糖尿病病人的大血管并发症的患病率 Prevalence of T2DM complications (macro-vascular) in urban cities 0.4% 0.8% 4.1% 4.0% 18.6% 11.1% 10.0% 0.0%5.0%10.0%15.0%20.0% CABG PTCA CHF AMI 心绞痛 Angina 卒中 Stroke TIA 53.32%的糖尿病病人至少患有一种并发症 53.32% of TII DM patients have at least one complication. 微血管并发症： 22.33% 22.33% of TII DM patients have DM micro complications. 大血管并发症：13.30% 13.30% of TII DM patients have DM macro complications. 两者兼有：17.69% 17.69% of TII DM patients have BOTH complications 2型糖尿病并发症 TII DM complications Source: ISIS Diabetic Therapy Monitor PhVI 2002 2型糖尿病并发症的危险性 Risk of Type2 Diabetes complications ISIS Diabetes Therapy Monitor PhVI 无并发症 Non-complicated (46.7%) CABG (0.2%)PTCA (0.5%) CHF (2.4%)Angina (10.9%) MI (2.3%)Stroke (7.7%) TIA (14.8%) 大血管并发症 Macro-vascular (13.3%) Foot Ulcer (3.0%)Amputation (0.3%) Clinical Blindness (1.5%)Photocoagulation (20.2%) Dialysis (0.4%)CRF (7.0%) 微血管并发症 Micro-vascular (22.3%)两者兼有 Both (17.7%) 有并发症 Complicated (53.3%) 所有糖尿病人群 Total Diabetic Population 100% Peripheral Neuropathy(21.2) 糖尿病并发症发病率（%） Diabetic complications % ISIS Diabetic Therapy Monitor PhVI 2002 0% 5% 10% 15% 20% 25% 神经病变 Neuropathy 光凝固术 Photocoagulation 心绞痛 Angina 脑血管病 Cerebrovascular disease 卒中 Stroke 短暂脑缺血发作 TIA 慢性肾衰 Chronic renal failure 足溃疡 Foot ulcer 慢性心衰 CHF 心肌梗死 Myocardial infarction 临床失明 Clinical blindness 其他心血管病 Other cardiovascular 经皮冠脉成形术 PTCA 透析 Dialysis 截肢 Amputation 冠脉旁路移植术 CABG 累积百分率 (Cumulative % of patients) 2型糖尿病(Type 2) 2型糖尿病并发症-平均住院天数 TII DM complications - Ave. Length of Hospital Stay (ALOS) 加权权住院时间时间（Weighted ALOS） 透析(Dialysis)40.5 足溃疡溃疡(Foot Ulcer)36.2 冠状动动脉旁路移植术术(CABG)33.0 卒中(Stroke)32.6 失明(Blindness)32.6 截肢(Amputation)31.2 肾肾衰(Renal failure)28.5 经经皮冠状动动脉成形术术(PTCA)23.5 短暂脑暂脑缺血发发作(TIA)22.5 急性心肌梗死(AMI)21.8 慢性心衰(CHF)21.5 外周神经经病变变（Peripheral Neuropathy)20.7 心绞绞痛(Angina)18.4 光凝固术术(Photocoagulation)16.3 Source: Result of ISIS Diabetic Patient Survey 2型糖尿病并发症-平均住院天数 TII DM complications - Ave. Length of Hospital Stay (ALOS) Source: Result of ISIS Diabetic Patient Survey 01020304050 AMI CHF 心绞痛 Angina CABG PTCA 卒中 Stroke TIA 足溃疡 Foot Ulcer 截肢 Amputation 失明 Blindness 光凝固术 Photocoagulation 肾衰 Renal failure 透析 Dialysis 药物治疗 Drug Treatments 98%以上的病人用口服降糖药单独治疗，或者采用胰岛素+口 服降糖药联合治疗或者是胰岛素单独治疗* Over 98% of patients are managed with either OHA alone, insulin + OHA or insulin monotherapy* 口服降糖药：64% 64% of patients on OHA 口服降糖药+胰岛素：17% 17% of patients on OHA & Insulin 胰岛素：18% 18% of patients on Insulin *Patients interview from ISIS Diabetic Therapy Monitor PhV 药物治疗 Drug Treatments Source: ISIS DM Therapy Monitor PhV Patient Interviews 18% 17% 2% 64% 单用口服降糖药(OHA alone)单用胰岛素(Insulin alone) 口服降糖药+胰岛素(Both OHA and Insulin)饮食控制+运动(On diet or sports) 主要内容 Contents 糖尿病流行病学 Epidemiology of diabetes mellitus CODE2导论 Introduction of CODE2 CODIC方法学 CODIC methodology CODIC项目糖尿病人口学特征 Demographics of diabetic patients in CODIC 2型糖尿病病人疾病负担 Disease burden of patients with type 2 diabetes 中国大城市II 型糖尿病直接医疗总成本 Total Direct Medical Cost of treating Type2 Diabetes in urban China 中国城市治疗2型糖尿病及其并发症的直接医疗总成本为 189.42亿RMB* (3.759亿城市人口) Total Direct Medical Cost of treating T2DM and its complication in urban China is billion RMB (US$2.29billion) (375.9m pop) (CODE2: 欧洲治疗1000万名以上2型糖尿病病人的直接医疗成本为290亿 欧元) (CODE2: Direct medical cost for 10million patients with Type II DM is 29 billion Euros( US$29.9billion). 该费用占中国医疗卫生总费用的3.98%（4764亿RMB ） This accounts for 3.98% of total China healthcare expenditure (476.4 billion RMB). (CODE2: 5%医疗卫生总费用) (CODE2: 5% of total healthcare expenditure). National Bureau of Statistics in China 2001 The Yearbook of Chinas cities 2000 Diabetologica (2002)45:S1-S4 该费用计算包括： This cost calculation includes： 仅包括中国大城市人口（3.759亿人） Only Chinas urban population is included ( 375.9 million) 糖尿病患病率4.8%，其中95%为2型糖尿病 Using diabetes prevalence rate of 4.8% of which 95% of all Diabetes are Type 2 Diabetes 只有30%病人得到诊断，得到诊断的病人中40%接受 治疗（诊断并治疗的病人占12%） Only 30% of patients are diagnosed of which 40% of patients get treated ( Diagnosed and treated is 12% of total) 46.7%的2型糖尿病患者无并发症 46.7%of T2DM patients do not have complications 53.3%的2型糖尿病患者有并发症 53.3% of T2DM patients have complications National Bureau of Statistics in China 2001 The Yearbook of Chinas cities 2000 China Pharmaceutical Report, Vol 7, No.4 ISIS Diabetic Therapy Monitor, Ph5 & 6 中国大城市2型糖尿病直接医疗总成本 Total Direct Medical Cost of treating Type2 Diabetes in urban China 10亿人民币 Billion RMB 476.4 18.94 0 50 100 150 200 250 300 350 400 450 500 中国的年医疗开支 Annual healthcare Expenditure in China 中国大城市治疗2型糖尿病 的每年直接医疗成本 Annual direct medical cost of treating T2DM in Urban China 3.98% 2 型糖尿病占总医疗卫生费用的比较:中国欧洲 Europe Comparison: T2 Diabetes as a % of total healthcare expenditure 国家(Countries)2型糖尿病占总医疗卫生 费用 百分比 (T2DM as % of total healthcare expenditure) 意大利(Italy)6.6% 德国(Germany)6.5% 中国(China)3.98% 法国(France)3.4% 英国(UK)2.5% 荷兰(Netherlands)1.6% 中国大城市治疗2型糖尿病及其并发症的总成本 Total cost of treating T2 Diabetes and its complications in urban China 成本(Cost) 人民币10亿 RMB(Billion) 直接医疗成本 Direct Medical Cost 18.94 直接非医疗成本 Direct Non-Medical Cost 2.32 间接成本 Indirect Cost 2.39 总成本 Total Cost 23.65(US$2.86) 中国大城市2型糖尿病直接医疗总成本 Direct medical cost of treating Type2 Diabetes in urban China 治疗无并发症2型糖尿病的直接医疗成本35.78亿元人民币 Direct medical cost of treating Type2 Diabetes without complications is 3.578 billion RMB. 治疗有并发症2型糖尿病的直接医疗成本153.64亿元人民币 Direct medical cost of treating Type2 Diabetes with complications is RMB 15.364 billion. 该费用占中国大城市治疗2型糖尿病直接医疗成本的 81.1% This accounts for 81.1% of direct medical cost of treating T2DM in urban China. National Bureau of Statistics in China 2001 The Yearbook of Chinas cities 2000 Epidemiology series for 21st Century (2000)4th version, Peoples Healthcare Publishing house ISIS Diabetic Therapy Monitor, Ph5 & 6 中国治疗糖尿病病人的直接医疗成本 Direct medical cost of treating Diabetic patients in China 10亿元人民币 Billion RMB 18.9% 81.1% 0.00% 50.00% 100.00% 直接医疗成本 Direct Medical Cost 有并发症病人的直接医疗成本(Direct Medical Cost for patients with complications 无并发症病人的直接医疗成本(Direct Medical Cost for patients without complications 每例病人的年均直接医疗成本 Average Annual Direct Medical Cost Per patient 每例病人的年均直接医疗成本，无并发症者为3726.36元，有 并发症者为14009.00元，治疗并发症比单纯治疗糖尿病的费用 高3.8倍 Average annual direct medical cost per patient was 3726.36 RMB without complications compared to 14009.00 RMB for patients with complications. It cost 3.8 times more to treat DM patients with complications. (CODE2:有糖尿病并发症使治疗费用升高3.5倍) (CODE2: Presence of diabetic related complications increase the costs by over 3.5 times. 年人均成本（3726.36元）占上海年人均可支配收入的32%，占西安年人均可支配 收入的73% This cost (3726.36 RMB) could account for 32% of per capita disposable income in Shanghai and 73% of that in Xian. National Bureau of Statistics in China 2001, The Yearbook of Chinas cities 2000 Epidemiology series for 21st Century (2000) 4th version, Peoples Healthcare Publishing house National Hospital Cost Yellow Book China 1997 China Pharmaceutical Report, Vol 7, No.4 ISIS Diabetic Therapy Monitor, Ph5 & 6 病人年均直接医疗成本 Average Annual Direct Medical Cost Per Patient 72.7%5124.24 西安(Xian) 69.6%5357.79 沈阳(Shenyang) 67.5%5524.54 武汉(Wuhan) 63.2%5894.27 成都(chengdu) 59.4%6275.98 重庆(Chongqing) 57.4%6489.97 济南(Jinan) 54.8%6800.23 南京(Nanjing) 40.2%9279.16 杭州(Hangzhou) 38.2%9761.57 广州(Guangzhou) 36.0%10,349.69 北京(Beijing) 31.8%11718.01 上海(Shanghai) 无并发症2型糖尿病治疗成本占人年均收入的比例 Treatment Cost of uncomplicated T2DM (3726.36 RMB) as % of APCI 人年均收入(RMB) Annual Per Capita Income 城市(CITY) 2001 Almanac of Chinas Economy 2型糖尿病并发症的经济负担 Economic burden of T2DM complications 2型糖尿病并发症的经济负担 Economic burden of Type2 Diabetes complications 2型糖尿病并发症的医疗成本占人均年收入比例 T2DM complications as a % of per capita income 不同城市治疗2型糖尿病的医疗成本 Total Medical Cost of treating T2DM in different cities 城市(CITY)治疗2型糖尿病的医疗成本 百万元人民币/年 Medical Cost of Treating TII DM (million RMB/year) 北京(Beijing)690 上海(Shanghai)544 武汉(Wuhan)373 沈阳(Shenyang)243 成都(Chengdu)179 广州(Guangzhou)164 National Bureau of Statistics in China 2001 The Yearbook of Chinas cities 2000 Epidemiology series for 21st Century (2000)4th version, Peoples Healthcare Publishing house National Hospital Cost Yellow Book, China 1997, China Pharmaceutical Report, Vol 7, No.4, ISIS Diabetic Therapy Monitor, Ph5 & 6 不同城市治疗2型糖尿病的医疗成本 Total Medical Cost of treating T2DM in different cities 城市(CITY)治疗2型糖尿病的直接医疗成本 百万元人民币/年 Direct Medical Cost of Treating TII DM (million RMB/year) 重庆(Chongqing) 328 西安(Xian)193 济南(Jinan)120 南京(Nanjing)95 杭州(Hangzhou)43 National Bureau of Statistics in China 2001 The Yearbook of Chinas cities 2000 Epidemiology series for 21st Century (2000) 4th version, Peoples Healthcare Publishing house National Hospital Cost Yellow Book China 1997 China Pharmaceutical Report, Vol 7, No.4 ISIS Diabetic Therapy Monitor, Ph5 & 6 中国大城市治疗2型糖尿病医疗成本（百万元RMB /年） Direct medical cost of treating T2DM in urban China 0100200300400500600700800 Medical Cost of treating TII DM in urban China (million RMB/year) 杭州Hangzhou南京Nanjing济南Jinan 广州Guangzhou 成都Chengdu西安Xian沈阳SY 重庆Chongqing 武汉Wuhan上海SH北京Beijing 中国大城市治疗 2型糖尿病医疗 成本(百万元 RMB /年) 心血管系统并发症的治疗成本占所有并发症治疗成本的52% Cardiovascular complications make up 52% of all complication cost Source: ISIS DM Therapy Monitor PhV Patient Interviews only includes TII DM patients with complications * includes AMI, CHF, Angina, CABG, PTCA 48% 52% 心血管系统并发症(Cardiovascular Complications*)其他(Others) 住院费用 Cost of Hospitalization 住院费用占治疗2型糖尿病病人总医疗成本的35%* Hospitalization accounts for 35% of total medical cost of treating T2DM patients*. (CODE2:最大的成本是住院费用，占总成本的30-65%，口服 降糖药仅占总成本的2-7%) (CODE2:The largest category of cost is Hospitalization, which accounts for 30-65% of total cost. OHA accounts for total 2-7% of total cost) Source: ISIS DM Therapy Monitor PhV Patient Interviews only includes TII DM patients with complications 药物成本 Drug cost 口服降糖药占治疗无并发症2型糖尿病总药物成本的60% In T2DM patients without complications, OHA accounted for 60% of direct medical cost 治疗患有并发症的2型糖尿病病人，总药物成本（口服降糖药 +治疗糖尿病并发症药物）占总医疗成本的30% In T2DM patients with complications, OHA and diabetic complication drugs accounted for 30% of t