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 CostofTreatingType2Diabetes complicationsinurbanChina 研究范围Studydefinition 只包括省会城市OnlyProvincialCapitalcitiesareincluded 主要内容Topics 糖尿病流行病学EpidemiologyofdiabetesmellitusCODIC方法学CODICmethodologyCODIC项目糖尿病人口学特征DemographicsofdiabeticpatientsinCODIC2型糖尿病病人疾病负担Diseaseburdenofpatientswithtype2diabetes 糖尿病的流行病学特征DiabetesEpidemiology 1995 2025年间 全球糖尿病患者已由1 35亿增长到3 0亿 表明糖尿病患病率将增长27 一般成年人群的预期增长率为11 Globally thenumberofpeoplewithdiabeteswillincreasefrom135mto300mbetween1995 2025 Thisrepresentsa27 increaseindiabetesprevalence comparedtoexpected11 increaseingeneraladultpopulation 全球2型糖尿病病例占所有糖尿病的90 中国为95 Type2diabetesaccountsfor90 ofdiabetescasesworld wide InChina 95 DiabetesCare 1998 21 1414 1431Diabetologica 2002 45 SI S4ChinaPharmaceuticalReportVol 7 No 4ISISDiabeticTherapyMonitor 2000 2002 PhV VI 中国2型糖尿病患病率Type2DiabetesprevalenceinChina 中国糖尿病的患病率估计为3 21 DiabetesprevalenceinChinaisestimatedat3 21 中国城市地区的患病率估计为4 8 PrevalenceinurbanChinaisestimatedat4 8 武汉 沈阳和西安 采用全国的糖尿病患病率4 8 ForWuhan ShenyangandXian diabetesthenationalprevalenceof4 8 wasused总人群中 30 的患者确诊Ofthosewithdiabetes 30 arediagnosed 确诊糖尿病病人中 40 得到治疗Ofthediagnoseddiabeticpopulation 40 aretreated ChinaPharmaceuticalReportVol 7 No 4ISISDiabeticTherapyMonitor Ph5 6 中国城市2型糖尿病患病率PrevalenceofType2DiabetesinurbancitiesinChina Epidemiologyseriesfor21stCentury Aug2000 4thversion People sHealthcarePublishinghouseChinaPharmaceuticalReportVol 7 No 4 2型糖尿病并发症Type2Diabetescomplications 2型糖尿病并发症对许多器官系统有直接损害 尤其是长期并发症 导致发病率和死亡率升高Type2Diabetescomplicationscanhaveadirectdetrimentaleffectstomanyorgansystems withsignificantlong termcomplicationsandimpactonmorbidityandmortality并发症分为两类 Thesecomplicationsfallinto2categories 大血管病变 心血管疾病和脑血管疾病MACROVASCULAR includesCardiovascularandCerebrovascular微血管病变 视网膜病 肾病 神经病MICROVASCULAR includesRetinopathy NephropathyandNeuropathy 糖尿病的并发症使危险性增加Diabetescomplicationsincreaserisk 糖尿病病人患心脏病和中风的危险度比非糖尿病病人高4倍Riskofheartdiseaseorstrokecanbe4Xhigherindiabetespatientsvs non diabeticpatients 2型糖尿病 高血压病人比非糖尿病 非高血压病人的死亡率高7倍Type2Diabetes hypertensivepatientshave7xincreasedmortalityvs non diabetic normotensivepatients糖尿病性视网膜病变是经济发达国家成年人失明和视觉失能的首要原因Diabeticretinopathyistheleadingcauseofblindnessandvisualdisabilityinadultsineconomicallydevelopedsocieties 糖尿病性肾病占终末期肾衰的40 Diabeticnephropathyaccountsfor40 ofend stagerenalfailure 糖尿病患者低位截肢的危险度比非糖尿病病人高40 Riskoflowerextremityamputationsis40 higherinDiabetespatients Vs non diabeticpatients DiabetesCare 1995 21 1414 1431 严格控制血糖的意义 英国前瞻性糖尿病研究 UKPDS 表明 UKPDSstudyshowedthefollowing 严格控制血糖可降低视网膜病 肾病 神经病的发生率Betterhyperglycemiacontrolreducesretinopathy nephropathyandpossibleneuropathy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Controllinghypertensionreducesstrokes heartfailure visualloss microvasularcomplicationsandDiabetes relateddeaths 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Insulinresistancemanagementshouldbeaimedatoptimalcontrolatbloodglucoseandhencereductionofco morbidities 主要内容Contents 糖尿病流行病学EpidemiologyofdiabetesmellitusCODIC方法学CODICmethodologyCODIC项目糖尿病人口学特征DemographicsofdiabeticpatientsinCODIC2型糖尿病病人疾病负担Diseaseburdenofpatientswithtype2diabetes CODIC方法学CODICmethodology 中国有11个省会城市参与了CODIC项目 CODICcovers11provincialcapitalChinesecities 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 Xi an Chongqing Hangzhou采访了200名内分泌专家Interviewsof200endocrinologists4000名糖尿病病人填写了调查问卷4000DiabetesPatientFormscompleted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Further806Type2diabetespatientswithcomplicationsand300diabeticpatientswithoutcomplicationsinterviewed 2型糖尿病患者抽样调查问卷Type2Diabetespatientsamplequestionnaire 所有的费用的数据来自对病人的访问AllCostdataderivedfromPatientinterviews请问您是否患有2型糖尿病的并发症 DoyousufferfromdiabeticcomplicationsduetoT2DM 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 Whichofthesecomplicationsorproceduresyouarecurrentlysufferingfrom haveyouundergoneinthelastyear complicationsaslistedinnextslide 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 HistoryofanyhospitalisationduetoT2DMoritscomplicationsduringthelastyear 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 NumberofmedicalconsultationsduetoT2DMoritscomplicationsinthelastyear onlypatientswithcomplicationsDUETOT2DMareincludedinthestudy 并发症 调查病人的样本量Complications PatientSurveySampleSize DMComplicationselectionbasedonISISPhVTherapyMonitorprevalencerate 主要内容Contents 糖尿病流行病学EpidemiologyofdiabetesmellitusCODIC方法学CODICmethodologyCODIC项目糖尿病人口学特征DemographicsofdiabeticpatientsinCODIC2型糖尿病病人疾病负担Diseaseburdenofpatientswithtype2diabetes 2型糖尿病病人的人口统计学特征Type2Diabetespatientdemographics 病人的平均年龄为58岁PatientMeanageis58yearsold 糖尿病平均病程约为6年Meanaveragedurationofdiabetesisabout6years 2型糖尿病的平均体重指数 BMI 为24kg m2MeanaverageBMIofT2DMpatientsis24kg m2WHO提出亚洲人的体重指数正常范围为18 5 23kg m2WHOrangeforacceptable normal oroptimumbody massindex BMI forAsianpopulationsshouldbenarrowedto18 5 23kg m2 Message 2型糖尿病人群有肥胖倾向Type2Diabetespopulationhasapropensityforobesity Lancet 2002 Vol360 血糖控制Glycaemiccontrol 32 的病人血糖控制差 HbAIc 7 5 32 ofpatientshavepoorglycemiccontrol definedasHbAIc 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Only37 ofpatientsonOHAand47 oninsulinhad good glycemiccontrol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 PatientstreatedwithdietandexercisehadameanHbAIcof7 23 comparedtopatientsonOHAwith7 43 andpatientsoninsulinwith6 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MostlikelyreflectstheprogressivedeteriorationofbetacellfunctionandthefailureofcurrentOHAtherapiestoprovidesustainedglycaemiccontrol ISISDiabeticTherapyMonitorPhVI2002AmericanDiabeticAssociationguidelines 大城市2型糖尿病病人的大血管并发症的患病率PrevalenceofT2DMcomplications macro vascular inurbancities ISISDiabeticTherapyMonitorPhVI2002 大城市2型糖尿病病人的微血管并发症的患病率PrevalenceofT2DMcomplications micro vascular inurbancities ISISDiabeticTherapyMonitorPhVI2002 大城市2型糖尿病病人的微血管并发症的患病率PrevalenceofT2DMcomplications micro vascular inurbancities 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 FootUlcer 失明 Blindness 光凝固术 Photocoagulation 透析 Dialysis 肾衰 RenalFailure 大城市2型糖尿病病人的大血管并发症的患病率PrevalenceofT2DMcomplications macro vascular inurbancities 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 ofTIIDMpatientshaveatleastonecomplication 微血管并发症 22 33 22 33 ofTIIDMpatientshaveDMmicrocomplications 大血管并发症 13 30 13 30 ofTIIDMpatientshaveDMmacrocomplications 两者兼有 17 69 17 69 ofTIIDMpatientshaveBOTHcomplications 2型糖尿病并发症TIIDMcomplications Source ISISDiabeticTherapyMonitorPhVI2002 2型糖尿病并发症的危险性RiskofType2Diabetescomplications ISISDiabetesTherapyMonitorPhVI 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 FootUlcer 3 0 Amputation 0 3 ClinicalBlindness 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TotalDiabeticPopulation 100 PeripheralNeuropathy 21 2 糖尿病并发症发病率 Diabeticcomplications ISISDiabeticTherapyMonitorPhVI2002 0 5 10 15 20 25 神经病变Neuropathy 光凝固术Photocoagulation 心绞痛Angina 脑血管病Cerebrovasculardisease 卒中Stroke 短暂脑缺血发作TIA 慢性肾衰Chronicrenalfailure 足溃疡Footulcer 慢性心衰CHF 心肌梗死Myocardialinfarction 临床失明Clinicalblindness 其他心血管病Othercardiovascular 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 ofpatients 2型糖尿病 Type2 2型糖尿病并发症 平均住院天数TIIDMcomplications Ave LengthofHospitalStay ALOS Source ResultofISISDiabeticPatientSurvey 2型糖尿病并发症 平均住院天数TIIDMcomplications Ave LengthofHospitalStay ALOS Source ResultofISISDiabeticPatientSurvey 0 10 20 30 40 50 药物治疗DrugTreatments 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 Over98 ofpatientsaremanagedwitheitherOHAalone insulin OHAorinsulinmonotherapy 口服降糖药 64 64 ofpatientsonOHA口服降糖药 胰岛素 17 17 ofpatientsonOHA Insulin胰岛素 18 18 ofpatientsonInsulin PatientsinterviewfromISISDiabeticTherapyMonitorPhV 药物治疗DrugTreatments Source ISISDMTherapyMonitorPhVPatientInterviews 18 17 2 64 单用口服降糖药 OHAalone 单用胰岛素 Insulinalone 口服降糖药 胰岛素 BothOHAandInsulin 饮食控制 运动 Ondietorsports 主要内容Contents 糖尿病流行病学EpidemiologyofdiabetesmellitusCODE2导论IntroductionofCODE2CODIC方法学CODICmethodologyCODIC项目糖尿病人口学特征DemographicsofdiabeticpatientsinCODIC2型糖尿病病人疾病负担Diseaseburdenofpatientswithtype2diabetes 中国大城市II型糖尿病直接医疗总成本TotalDirectMedicalCostoftreatingType2DiabetesinurbanChina 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 TotalDirectMedicalCostoftreatingT2DManditscomplicationinurbanChinaisbillionRMB US 2 29billion 375 9mpop 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 Directmedicalcostfor 10millionpatientswithTypeIIDMis29billionEuros US 29 9billion 该费用占中国医疗卫生总费用的3 98 4764亿RMB Thisaccountsfor3 98 oftotalChinahealthcareexpenditure 476 4billionRMB CODE2 5 医疗卫生总费用 CODE2 5 oftotalhealthcareexpenditure NationalBureauofStatisticsinChina2001TheYearbookofChina scities2000Diabetologica 2002 45 S1 S4 该费用计算包括 Thiscostcalculationincludes 仅包括中国大城市人口 3 759亿人 OnlyChina surbanpopulationisincluded 375 9million 糖尿病患病率4 8 其中95 为2型糖尿病Usingdiabetesprevalencerateof4 8 ofwhich95 ofallDiabetesareType2Diabetes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 Only30 ofpatientsarediagnosedofwhich40 ofpatientsgettreated Diagnosedandtreatedis12 oftotal 46 7 的2型糖尿病患者无并发症46 7 ofT2DMpatientsdonothavecomplications53 3 的2型糖尿病患者有并发症53 3 ofT2DMpatientshavecomplications NationalBureauofStatisticsinChina2001TheYearbookofChina scities2000ChinaPharmaceuticalReport Vol7 No 4ISISDiabeticTherapyMonitor Ph5 6 中国大城市2型糖尿病直接医疗总成本TotalDirectMedicalCostoftreatingType2DiabetesinurbanChina 10亿人民币BillionRMB 476 4 18 94 0 50 100 150 200 250 300 350 400 450 500 中国的年医疗开支 AnnualhealthcareExpenditureinChina 中国大城市治疗2型糖尿病的每年直接医疗成本 AnnualdirectmedicalcostoftreatingT2DMinUrbanChina 3 98 2型糖尿病占总医疗卫生费用的比较 中国 欧洲EuropeComparison T2Diabetesasa oftotalhealthcareexpenditure 中国大城市治疗2型糖尿病及其并发症的总成本TotalcostoftreatingT2DiabetesanditscomplicationsinurbanChina 成本 Cost 人民币10亿RMB Billion 直接医疗成本DirectMedicalCost 18 94 直接非医疗成本DirectNon MedicalCost 2 32 间接成本IndirectCost 2 39 总成本TotalCost 23 65 US 2 86 中国大城市2型糖尿病直接医疗总成本DirectmedicalcostoftreatingType2DiabetesinurbanChina 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DirectmedicalcostoftreatingType2Diabeteswithoutcomplicationsis3 578billionRMB 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DirectmedicalcostoftreatingType2DiabeteswithcomplicationsisRMB15 364billion 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 Thisaccountsfor81 1 ofdirectmedicalcostoftreatingT2DMinurbanChina NationalBureauofStatisticsinChina2001TheYearbookofChina scities2000Epidemiologyseriesfor21stCentury 2000 4thversion People sHealthcarePublishinghouseISISDiabeticTherapyMonitor Ph5 6 中国治疗糖尿病病人的直接医疗成本DirectmedicalcostoftreatingDiabeticpatientsinChina 10亿元人民币BillionRMB 18 9 81 1 0 00 50 00 100 00 直接医疗成本DirectMedicalCost 有并发症病人的直接医疗成本 DirectMedicalCostforpatientswithcomplications 无并发症病人的直接医疗成本 DirectMedicalCostforpatientswithoutcomplications 每例病人的年均直接医疗成本AverageAnnualDirectMedicalCostPerpatient 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Averageannualdirectmedicalcostperpatientwas3726 36RMBwithoutcomplicationscomparedto14009 00RMBforpatientswithcomplications Itcost3 8timesmoretotreatDMpatientswithcomplications CODE2 有糖尿病并发症使治疗费用升高3 5倍 CODE2 Presenceofdiabeticrelatedcomplicationsincreasethecostsbyover3 5times 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 Thiscost 3726 36RMB couldaccountfor32 ofpercapitadisposableincomeinShanghaiand73 ofthatinXi an NationalBureauofStatisticsinChina2001 TheYearbookofChina scities2000Epidemiologyseriesfor21stCentury 2000 4thversion People sHealthcarePublishinghouseNationalHospitalCostYellowBookChina1997ChinaPharmaceuticalReport Vol7 No 4ISISDiabeticTherapyMonitor Ph5 6 病人年均直接医疗成本AverageAnnualDirectMedicalCostPerPatient 72 7 5124 24 西安 Xi an 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TreatmentCostofuncomplicatedT2DM 3726 36RMB as ofAPCI 人年均收入 RMB AnnualPerCapitaIncome 城市 CITY 2001AlmanacofChina sEconomy 2型糖尿病并发症的经济负担EconomicburdenofT2DMcomplications 2型糖尿病并发症的经济负担EconomicburdenofType2Diabetescomplications 2型糖尿病并发症的医疗成本占人均年收入比例T2DMcomplicationsasa ofpercapitaincome 不同城市治疗2型糖尿病的医疗成本TotalMedicalCostoftreatingT2DMindifferentcities NationalBureauofStatisticsinChina2001TheYearbookofChina scities2000Epidemiologyseriesfor21stCentury 2000 4thversion People sHealthcarePublishinghouseNationalHospitalCostYellowBook China1997 ChinaPharmaceuticalReport Vol7 No 4 ISISDiabeticTherapyMonitor Ph5 6 不同城市治疗2型糖尿病的医疗成本TotalMedicalCostoftreatingT2DMindifferentcities NationalBureauofStatisticsinChina2001TheYearbookofChina scities2000Epidemiologyseriesfor21stCentury 2000 4thversion People sHealthcarePublishinghouseNationalHospitalCostYellowBookChina1997ChinaPharmaceuticalReport Vol7 No 4ISISDiabeticTherapyMonitor Ph5 6 中国大城市治疗2型糖尿病医疗成本 百万元RMB 年 DirectmedicalcostoftreatingT2DMinurbanChina 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 Cardiovascularcomplicationsmakeup52 ofallcomplicationcost Source ISISDMTherapyMonitorPhVPatientInterviewsonlyincludesTIIDMpatientswithcomplications includesAMI CHF Angina CABG PTCA 48 52 心血管系统并发症 CardiovascularComplications 其他 Others 住院费用CostofHospitalization 住院费用占治疗2型糖尿病病人总医疗成本的35 Hospitalizationaccountsfor35 oftotalmedicalcostoftreatingT2DMpatients 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 ThelargestcategoryofcostisHospitalization whichaccountsfor30 65 oftotalcost OHAaccountsfortotal2 7 oftotalcost Source ISISDMTherapyMonitorPhVPatientInterviewsonlyincludesTIIDMpatientswithcomplications 药物成本Drugcost 口服降糖药占治疗无并发症2型糖尿病总药物成本的60 InT2DMpatientswithoutcomplications OHAaccountedfor60 ofdirectmedicalcost治疗患有并发症的2型糖尿病病人