HypoglycemIa in POrtugal Study (HIPOS) was a sequence of three observational studies to capture the overall panorama of hypoglycemia events in Portugal in different settings of healthcare assistance: ambulatory (HIPOS-PHARMA), emergency room (HIPOS-ER), and hospitalizations (HIPOS-WARD). ĭespite the considerable and increasing burden of DM for the NHS, national data on hospital admissions due to hypoglycemia are scarce, hindering successful disease management and prevention of adverse events. DM is a main cause of hospitalization (16%), with a mean duration of 3.4 days (or 11.6 days, excluding day-care episodes), which is more than the average duration of general hospitalization causes in the Portuguese National Health System (NHS). This disease was responsible for 4.0% of all-cause deaths in that year. In 2015, a prevalence of 13.3% and an incidence of 699.5/100,000 habitants were estimated for patients with DM aged from 20 to 79 years in Portugal. Consequentially, there is great concern regarding the risk of hypoglycemia events during the metabolic control of patients with DM1 and DM2. Hypoglycemia events are one of the most frequent antidiabetic drug-related adverse events and usually the most common endocrine emergency leading to hospitalization. To avoid micro- and macrovascular complications, international and national guidelines usually recommend lowering hemoglobin A1c (HbA1c) to less than 7.0% for most patients with DM through lifestyle management and, when necessary, pharmacological therapies. Therefore, DM is considered one of the main public health issues, affecting both patients’ health and governments’ healthcare budgets.
The economic healthcare burden incurred for patients with DM expected for 2045 (USD 625 billion) was already surpassed in 2017 (ca. There were an estimated 425 million cases of DM worldwide in 2017, with an expected increase up to 629 million by 2045 due to the continuous rise in prevalence. Type 1 DM (DM1) is an autoimmune variation that mostly affects the young, while type 2 DM (DM2) is the most frequent subtype (90%), commonly associated with unhealthy lifestyles and genetic and socioeconomic factors. DM is a major cause of cardiovascular events, being often associated with premature death. Uncontrolled diabetes mellitus (DM) is characterized by deviations in insulin secretion/action, affecting glucose metabolism with important consequences for the patient’s overall health and quality of life. HIPOS-WARD’s findings confirm and support both the substantial clinical and economic impact of hospitalization due to hypoglycemia in Portugal. The mean cost increased with repeated hypoglycemic events (2191.67 €), correlated complications (2109.26 €), and death (5253.38 €). Patients treated with insulin-based regimens (2267.76 €) and type 2 diabetes (2051.29 €) had the highest mean costs. Overall, the cost per hypoglycemia episode leading to hospitalization averaged 2042.52 € (range 194.76–16,762.87 €).
DM1 WITH HYPOGLYCEMIA ICD 10 DRIVER
Bed occupancy was the main cost driver (772.09 €) and indirect cost averaged 140.44 €. Overall mean costs per patient were medication, 45.45 € laboratory analysis, 218.14 € examinations, 64.91 € physician and nurse time, 268.55 € and 673.39 €, respectively. Half of the patients (50.0%) were on insulin-based therapy, followed by 30.1% on a secretagogue-based regimen, 9.7% on non-secretagogue therapy, and 10.2% on a combination of insulin and secretagogue. Of the 176 patients with diabetes mellitus enrolled, 86% had type 2 diabetes. Absenteeism was also estimated for active workers on the basis of the human capital approach. The applied microcosting approach was based on healthcare resource data, collected from patients’ charts upon ward admission until discharge, and unitary costs from official/public data sources. Observational, cross-sectional study, conducted in 16 Portuguese centers for 22 months.
The HIPOS-WARD (Hypoglycemia In Portugal Observational Study-Ward) aimed to characterize ward admissions due to hypoglycemia episodes in treated patients with diabetes and assess their economic impact to the National Health System.
Hypoglycemia leading to hospitalization is associated with adverse economic outcomes, although the real burden is unknown.
0 kommentar(er)
