| Objective:To evaluate treatment costs of diabetes home nursing APP platform management in patients with type 2 diabetes for 6 months,12 months,and analyse the cost-effectiveness,cost-utility according to the result of clinical indexes,self-management indexes and quality of life.Methods:Toltal of 100 patients with type 2 diabetes who use insulin treatment Initially were randomly divided into conventional management group(control group,n=50)and home nursing APP platform management group(intervention group,n=50 cases).On the basis of that patients have learn to the method of insulin injection,ControI group received routine health education(diabetes self-management training and regular follow-up in the clinic),intervention group received the conventional management and application of diabetes home nursing APP platform at the same time.Before intervention,intervention after 6 months,12 months after intervention,the questionnaire(General situation,clinical control index and treatment costs),SDSCA-6 and EQ-VAS were completed respectively,Then cost-effective analysis and cost-utility were assessed at the end of the study.Results:1)Main measurement:6 months after intervention,compared with those before intervention,fasting blood glucose,postprandial 2 hour blood glucose,glycosylated hemoglobin,triglyceride(experimental group),high-density lipoprotein(control group),self-management level and quality of life of experimental group and control group were significantly improved(P<0.05).After 12 months of intervention,all indexes in the experimental group improved significantly compared with that before intervention(P<0.05).The glycemic index,self-management level and quality of life in the control group improved significantly(P<0.05),and there was no improvement in blood lipid level.After intervention for 6 months,the average level of 2 hour postprandial blood glucose and glycosylated hemoglobin in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05),and no significant difference in other indicators.After 12 months of intervention,2 hours after meal,the blood glucose,glycated hemoglobin,blood lipid,self management level and quality of life in the experimental group were all superior to the control group(P<0.05).2)Treatment costs:During 0～6 months and 0～12 months,The cost of medical treatment in the intervention group was 2109.56 RMB,3534.33 RMB and the control group of 1977.63RMB and 3470.63RMB.The total cost of medical treatment and the cost of direct medical treatment in the intervention group were higher than those in the control group,while the direct non medical cost and the indirect cost were lower than those of the control group.3)Cost-effective analysis:During 0～12 months,the experimental group reduced the lmmol/L fasting blood glucose to 1101.03RMB,reduced the lmmol/L hour after meal 2 hours blood sugar needed to spend 778.48RMB,reduced 1 units glycosylated hemoglobin to spend 1071.03RMB,the self management score increased 1 points needed to spend 313.32RMB.In the control group,the clinical outcomes were reduced by 1 units needed to spend 2268.36RMB,1592.01RMB,1176.47RMB and 1112.37RMB respectively,and the cost of the unit effect was higher than that of the experimental group.compared with the control group,the reduction of lmmol/L fasting blood glucose,2 hours postprandial blood glucose and 1 units of glycosylated hemoglobin per group were lower than those in the control group.The incremental cost-effectiveness of the experimental group was 37.91RMB,26.99RMB and 182RMB,and the 1 points of self management score was 7.32RMB.4)Cost-utility analysis:During the 0-12 months,the cost of acquiring QALYs per unit was 3462.00RMB in the experimental group and 4284.68RMB in the control group.The cost of the unit QALYs in the control group was 822.68RMB more than that in the experimental group.Compared to the control group,a unit of QALYs per unit in the experimental group just need to spend 245RMB.Conclusion:Home Nursing APP Platform has a better economic benefit and social benefit than conventional management mode on improvement of clinical indexes,quality of life and self-management skills. |
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