Diabetes care cascade in Ukraine: an analysis of breakpoints and opportunities for improved diabetes outcomes

Robyn Margaret Stuart,Olena Doroshenko,Feng Zhao,Nicole Fraser-Hurt,Volodymyr Mykhailets,Romesh Abeysuriya,Tetyana Kryvchun,Nina Durdykulyieva,Elvira Kaidashova,Olga Khan,Viktor Lysak,Alla Bredikhina,David Wilson,Zara Shubber

doi:10.1186/s12913-020-05261-y

Robyn Margaret Stuart, Olena Doroshenko + Show 12 more

Open Access

https://doi.org/10.1186/s12913-020-05261-y

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Abstract

BackgroundDiabetes is one of the leading causes of poor health and high care costs in Ukraine. To prevent diabetes complications and alleviate the financial burden of diabetes care on patients, the Ukrainian government reimburses diabetes medication and provides glucose monitoring, but there are significant gaps in the care continuum. We estimate the costs of providing diabetes care and the most cost-effective ways to address these gaps in the Poltava region of Ukraine.MethodsWe gathered data on the unit costs of diabetes interventions in Poltava and estimated expenditure on diabetes care. We estimated the optimal combination of facility-based and outreach screening and investigated how additional funding could best be allocated to improve glucose control outcomes.ResultsOf the ~ 40,000 adults in diabetes care, only ~ 25% achieved sustained glucose control. Monitoring costs were higher for those who did not: by 10% for patients receiving non-pharmacological treatment, by 61% for insulin patients, and twice as high for patients prescribed oral treatment. Initiatives to improve treatment adherence (e.g. medication copayment schemes, enhanced adherence counseling) would address barriers along the care continuum and we estimate such expenditures may be recouped by reductions in patient monitoring costs. Improvements in case detection are also needed, with only around two-thirds of estimated cases having been diagnosed. Outreach screening campaigns could play a significant role: depending on how well-targeted and scalable such campaigns are, we estimate that 10–46% of all screening could be conducted via outreach, at a cost per positive patient identified of US$7.12–9.63.ConclusionsInvestments to improve case detection and treatment adherence are the most efficient interventions for improved diabetes control in Poltava. Quantitative tools provide essential decision support for targeting investment to close the gaps in care.

Highlights

Diabetes is one of the leading causes of poor health and high care costs in Ukraine
The World Health Organization (WHO) estimates that diabetes was the seventh leading cause of death in 2016, and projections indicate that the burden is likely to continue growing
It can be helpful to measure what proportion of the population has progressed to each consecutive stage in the care continuum; this kind of cascade analysis has been effectively applied to many areas of health, including to diabetes care in the U.S [7] and in South Africa [8]

Summary

Introduction

Diabetes is one of the leading causes of poor health and high care costs in Ukraine. We estimate the costs of providing diabetes care and the most cost-effective ways to address these gaps in the Poltava region of Ukraine. It is imperative to ask whether there may be scope for improvements in the delivery of services designed to guide patients through the continuum of care To address this question, it can be helpful to measure what proportion of the population has progressed to each consecutive stage in the care continuum; this kind of cascade analysis has been effectively applied to many areas of health, including to diabetes care in the U.S [7] and in South Africa [8]

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