Methodology And Empirical Study On The Economic Burden Of Diabetes Mellitus

The economic burden of Diabetes Mellitus (DM) become huge and imposed greatchallenge to the healthcare system. It is critical to have a clear understanding on theeconomic burden of DM. There is great difference in the present outcomes ofeconomic studies on DM due to the heterogeneity in study design and methods. Thisstudy was to explore the economic burden and medical cost of DM with different datasources and to explore the reasons for variation in economic burden studies.The face-to-face interview was used to obtain the direct medical cost (DMC), directnon-medical cost, indirect cost (IC) and total economic burden in a community inBeijing and one tier3hospital in Tianjin. In2011,288patients with type2diabetesmellitus (T2DM) have the DMC, DNMC, IC and total cost at18904Yua n、909Yua n、380Yuan and20193Yuan per year. The economic burden for273patients withT2DM in Tianjin were27619Yua n,1647Yua n,1092Yuan and30358Yuan for DMC,DNMC and IC。The reason for difference in economic burden of the two cities wereconsidered to be the medical behavior and disease status, which could attribute to theselection bias of study population.The inpatient cost for1409patients with DM was studied with10%sample of TianjinUrban Employee Basic Medical Insurance (UEBMI) database. In2007, per admissionand the annual inpatient costs were6599and9662Yuan. The annual inpatient cost forretired DM patients were higher than the working (10010vs.8200Yuan) whereas theinpatient cost per admission for the working was higher than the retired (7180vs.6494). The severe complication status could be the reason for higher annual inpatientcost for the retired and the preference of higher tier hospitals was the reason for thehigher for the inpatient cost per admission for the working. The disease status andmedical preference were considered as the key factors of medical cost for patientswith DM.The nation-wide questionnaire survey with20internists from20tier2/3hosptials in9cities in China was to capture the event cost and state cost for DM relatedcomplications. The event and state costs for DM related complications per patientwere40427Yuan and13103Yuan for acute myocardial infarction (AMI); angina30455Yua n and9405Yua n; congestive heart failure22212Yua n and6529Yua n;ischemic stroke20799Yua n and9067Yua n; peripheral vascular disease21662Yuan and9663Yua n; neuropathy14408Yuan and5528Yua n; ESRD with haemodialysis72761Yua n and61427Yua n; ESRD with peritoneal dialysis50479Yuan and41173Yuan; severe hypoglycemic4718Yuan; ketoacidosis (DKA)9663Yua n.The systematic review of the previous literatures on economic burden of DM was toanalyze how the methods, study population, cost constitute, etc affect the economicburden and to explore the key factors to economic burden. The result shows that thedisease status and economic background were the key factors. The difference inmethod and cost constitute could explain the variation of methodology. Thedemographics, disease status and the inclusion and exclusion criteria could be theexpressed as sample selection bias. Consequently, the variation in methodology,sample selection bias, the economic background was deemed as the key influentialfactors.In conclusion, the key impact factors to the heterogeneity in economic burden of DMwere variation in methodology, sample selection bias and the economic background.Attention should be paid to the potential impact of methodology on cost-of-illnessstudies.