Economic Burden Of Type Research Articles

The Economic Burden of Type 2 Diabetes Mellitus in Pakistan: A Cost of Illness Study.

Type 2 Diabetes Mellitus (T2DM) is a highly prevalent disease with a chronic nature and poses a significant health burden worldwide, with no exception in Pakistan. Hence, this study aimed to explore the financial burden of T2DM in Pakistan through cost of illness analysis. A prevalence-based, cross-sectional study was conducted using a structured data collection tool from the patient's perspective. Through structured interviews by trained data collectors, the data regarding direct medical costs, direct non-medical costs, and indirect costs were collected and further verified through prescriptions and bills. After testing the normality of data, mean and median with interquartile range were used to present cost data, while non-parametric tests, i.e., the Mann-Whitney U test and the Kruskal-Wallis test, were used to assess factors associated with costs, as cost data were not normally distributed. The study included 522 participants, with a majority being female (54%) and aged between 41 and 60 years (64%). The mean annual total cost per patient was USD 235.1 (median = USD 162.8), comprising direct medical costs, 93.2% (mean = USD 219.2; median = USD 150.0), direct non-medical costs, 5.3% (mean = USD 12.4; median = USD 7.1), and indirect costs, 1.5% (mean = USD 3.5; median = USD 1.9). Costs were significantly higher for patients with advanced age, high literacy, higher household incomes, duration of diabetes, more than one complication, and using combination therapy. The economic burden of T2DM in Pakistan is substantial, with medication costs being the largest component. Effective management strategies and policy interventions are crucial to mitigate this burden and improve the economic and health outcomes for diabetic patients.

Trends in economic burden of type 2 diabetes in China: Based on longitudinal claim data.

Diabetes is a major health issue in China that has a significant economic burden on society. Understanding the economic impact of diabetes can help policymakers make informed decisions about healthcare spending and priorities. This study aims to estimate the economic burden of patients with diabetes in an urban setting in China and to identify the impact of hospitalization and complications on health care costs for people with diabetes. The study was conducted in a sample city located in eastern China. All patients diagnosed with diabetes before January 2015 were identified from the official health management information system, and their social demographics and records of their health care uses and costs were extracted from the claim database from 2014 to 2019. Six groups of complications were identified according to ICD-10 codes. The diabetes-related direct medical cost (DM cost) was described for patients in stratified groups. A multiple linear regression model was applied to identify the effect of hospitalization and complications on the DM cost of diabetic patients. Our research included 44,994 patients with diabetes, the average annual DM costs for diabetic patients increased from 1,292.72 USD in 2014 to 2,092.87 USD in 2019. The costs of diabetes are closely related to hospitalizations and the type and number of complications. The average annual DM cost of patients who were hospitalized was 2.23 times that of those without hospitalization, and it rose as the number of complications increased. Cardiovascular complications and nephropathic complications were the complications that had the greatest impact on patients' DM costs, increasing by an average of 65 and 54%, respectively. The economic burden of diabetes in urban China has increased significantly. Hospitalization and the type and number of complications have significant impacts on the economic burden of patients with diabetes. Efforts should be made to prevent the development of long-term complications in the population with diabetes.

Economic burden of type 2 diabetes in Iran: A cost-of-illness study.

Type 2 diabetes mellitus (T2DM) is a prevalent public health problem worldwide, and the economic burden of the disease poses one of the main challenges for health systems in low- and middle-income countries. This study aimed to estimate the economic burden of T2DM in Iran, in 2018. This was a cost-of-illness study. Three hundred and seventy-five patients with T2DM who were referred to Imam Reza and Sina's educational and therapeutic centers and Asad Abadi clinic in Tabriz, Iran, in 2018 were included. A researcher-constructed checklist was used for data collection. Data were analyzed using EXCEL and SPSS software version 22. Total economic burden of diabetes was estimated at 152,443,862,480.3 (purchasing power parity[PPP], Current International $) (approximately 7.69% of GDP, PPP, Current International $). The mean total direct and indirect costs were 11,278.68 (PPP) (62.35% of mean total cost) and 6808.88 (PPP, Current International $) (37.64% of the total cost), respectively. The mean total direct medical cost and the direct nonmedical cost were 10,819.43 (PPP, Current International $) (59.81% of mean total cost) and 459.24 (PPP, Current International $) (2.53% of mean total cost) per patient, respectively. Besides, the mean direct medical cost was 6.18 times the total per capita expenditure on health, and the total direct medical cost was 8.9% times the total expenditure on health. Diabetes imposes a substantial economic burden on patients, health systems, and the whole economy. Besides, since the cost of the disease in patients treated with insulin and those with diabetes complications is significantly higher, the reinforcement of self-care measures and focusing on modifying lifestyle (dietary modification and physical activity) in patients with T2DM can significantly reduce the costs of the disease.

Artificial Intelligence-based Prediction of Diabetes and Prediabetes Using Health Checkup Data in Korea

ABSTRACT The economic burden of Type 2 Diabetes (T2D) on society has increased over time. Early prediction of diabetes and prediabetes can reduce treatment cost and improve intervention. The development of (pre)diabetes is associated with various health conditions that can be monitored by routine health checkups. This study aimed to develop amachine learning-based model for predicting (pre)diabetes. Our frameworks were based on 22,722 patient samples collected from 2013 to 2020 in ageneral hospital in Korea. The disease progression was divided into three categories based on fasting blood glucose: normal, prediabetes, and T2D. The risk factors at each stage were identified and compared. Based on the area under the curve, the support vector machine appeared to have optimal performance. At the normal and prediabetes stages, fasting blood glucose and HbA1c are prevalent risk features for the suggested models. Interestingly, HbA1c had the highest odds ratio among the features even in the normal stage (FBG is less than 100). In addition, factors related to liver function, such as gamma-glutamyl transpeptidase can be used to predict progression from normal to prediabetes, while factors related to renal function, such as blood urea nitrogen and creatinine, are prediction factors of T2D development.

887-P: Productivity and Medical Costs Due to Diabetes in Adults Aged 18–64 Years with Large Employer-Sponsored Insurance

Despite a substantial economic burden of type 2 diabetes (T2D) on the working population, the costs of T2D for employers are not well characterized. We estimated productivity losses and medical costs due to T2D among employees aged 18-64 years using 2018-20MarketScan® databases. We estimated missed days due to absences, short-term disability (STD) , and long-term disability (LTD) attributable to T2D, overall and by age and sex. We converted these losses into costs by multiplying them by an average hourly wage. We used two-part and generalized linear models (controlling for age, sex, state of residence, employer industry type, and Charlson Comorbidity Index score) to estimate the productivity costs and medical costs in total and by service type. All costs were in 20USD. Overall, employees with T2D had 68% higher costs measured in productivity losses and medical services than those without diabetes (Table) , yielding a total cost attributable to T2D of $6,933. Most of the extra cost (90%) was from medical costs, followed by productivity costs due to STD (7%) , absences (2%) , and LTD (1%) . The youngest group had higher STD days and outpatient costs. Females had more absences and STD days and higher outpatient costs than males. Our estimates may assist employers in assessing potential financial gains from improved efforts to prevent and manage T2D in the workplace. Disclosure J.Park: None. E.Luman: None. P.Zhang: None.

An Integrated Medical-Psychological Approach in the Routine Care of Patients with Type 2 Diabetes: A Pilot Study to Explore the Clinical and Economic Sustainability of the Healthcare Intervention

The economic burden of Type 2 Diabetes Mellitus (T2DM) is a challenge for sustainability. Psychological factors, healthy behaviors, and stressful conditions are predictive and prognostic factors for T2DM. Focusing on psychological factors can reduce costs and help ensure the sustainability of diabetes care. The study aimed to support an integrated medical-psychological approach in the care of patients with T2DM. A group of patients undergoing usual healthcare treatment was compared to patients who received a psychotherapeutic intervention in addition to standard treatment. The study’s outcomes were: physical health (blood glucose, glycated hemoglobin, blood lipids, blood pressure); lifestyle (cigarettes, alcoholic drinks, physical activity, body mass index); mental health (anxiety, depression, stress, coping styles, alexithymia, emotion regulation, locus of control); costs (number of referrals to a specialist, standard cost of each visit). We examined the change from baseline to 24-week follow-up. Compared to the Standard Group, the Integrated Group reported a reduction in blood lipids and triglycerides, chronic depressive and anxious mood states, patient emotional coping, and the number of specialist visits and diagnostic tests. Close collaboration between diabetologists and psychologists is feasible, and it is worth considering integrated care as an option to contain and make healthcare spending more sustainable.

Economic burden of type 2 diabetes mellitus management: Epidemiological determinants from a coastal community of Southern India.

Expenditure on diabetes mellitus is increasing worldwide and is determined by multiple factors and knowledge about these factors may help to improve patient management and reduce health-care cost. The present study aims to determine the factors influencing the expenditure incurred by patients with type 2 diabetes mellitus (T2DM). A cross-sectional survey was conducted among 809 patients with T2DM from a coastal community in Southern India. Expenditure incurred for the management of T2DM in the previous year was collected using a predesigned survey tool. Duration of disease, source of diabetes care, presence of comorbidities, hospitalization, and adherence to medications were studied as potential cost predictors. Age, gender, education, occupation, and socioeconomic status as key determinants were evaluated. Expenditure incurred by patients with T2DM was estimated to be INR 5041 (2516-11,224) annually while the presence of comorbidities led to higher expenditure, INR 9133 (4034-19,053). Medication and hospitalization were the major drivers of direct cost. Subjects visiting private health facilities had a higher median cost with respect to diabetes-related care. Advancing age, male gender, high socioeconomic status, higher literacy, and longer duration of diabetes were identified as significant independent predictors of cost on multivariate analysis. The high cost of diabetes supports the need for strengthening public and private primary care facilities to provide standard care for diabetes.

Current Perspectives on the Impact of the National Diabetes Prevention Program: Building on Successes and Overcoming Challenges.

To address the public health and economic burden of type 2 diabetes, the Centers for Disease Control and Prevention (CDC) began dissemination of the National Diabetes Prevention Program (NDPP) in the United States in 2010. Based on the intensive lifestyle intervention from a large efficacy trial, the NDPP aims to reduce incidence through lifestyle change and weight loss. This narrative review summarizes evidence on reach, effectiveness, and sustainability of the NDPP, while highlighting opportunities to overcome challenges in these areas. Major successes include reaching hundreds of thousands of at-risk individuals across the nation, with notable effectiveness upon full participation and widespread insurance coverage. Yet, more work is needed to ensure greater public health impact, particularly among priority populations at heightened risk who also experience disparities in program outcomes. Preliminary evidence suggests a number of strategies may improve reach and effectiveness of the NDPP, often with more rigorous study needed prior to widespread uptake. Updating the NDPP to better match the current evidence-base may also be important, such as directly targeting glycemia with a patient-centered approach and promoting metformin as an adjunct or second-line treatment. Finally, revisiting pay-for-performance reimbursement models may be critical to sustainability by ensuring adequate availability of suppliers and ultimately reducing diabetes prevalence.

Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses

ABSTRACT Objectives: To estimate the clinical and economic burden of type 2 diabetes (T2D) in established (EST) and emerging markets (EMG). Methods: Three systematic literature reviews were conducted in MEDLINE and Embase to capture all relevant publications reporting 1) the epidemiology of T2D and complications in T2D and 2) the economic burden of T2D and associated complications. Results: In total, 294 studies were included in this analysis. Evidence indicates a high and increasing overall prevalence of T2D globally, ranging up to 23% in EMG markets and 14% in EST markets. Undiagnosed cases were higher in EMG versus EST markets (up to 67% vs 38%), potentially due to a lack of education and disease awareness in certain regions, that could lead to important clinical and economic consequences. Poor glycemic control was associated with the development of several complications (e.g. retinopathy, cardiovascular diseases and nephropathy) that increase the risk of morbidity and mortality. Direct costs were up to 9-fold higher in patients with vs without T2D-related complications. Conclusions: The burden of T2D, related complications and inherent costs are higher in emerging versus established market countries. This review explores potential strategies to reduce costs and enhance outcomes of T2D treatment in developing countries.

Methodology of the health economic evaluation of the Feel4Diabetes-study

BackgroundThe clinical and economic burden of type 2 diabetes mellitus on society is rising. Effective and efficient preventive measures may stop the increasing prevalence, given that type 2 diabetes mellitus is mainly a lifestyle-driven disease. The Feel4Diabetes-study aimed to tackle unhealthy lifestyle (unhealthy diet, lack of physical activity, sedentary behaviour, and excess weight) of families with a child in the first grades of elementary school. These schools were located in regions with a relatively low socio-economic status in Belgium, Bulgaria, Finland, Greece, Hungary and Spain. Special attention was paid to families with a high risk of developing type 2 diabetes mellitus.MethodsThe aim of this paper is to describe the detailed methodology of the intervention’s cost-effectiveness analysis. Based on the health economic evaluation of the Toybox-study, both a decision analytic part and a Markov model have been designed to assess the long-term (time horizon of 70 year with one-year cycles) intervention’s value for money. Data sources used for the calculation of health state incidences, transition probabilities between health states, health state costs, and health state utilities are listed. Intervention-related costs were collected by questionnaires and diaries, and attributed to either all families or high risk families only.ConclusionsThe optimal use of limited resources is pivotal. The future results of the health economic evaluation of the Feel4Diabetes-study will contribute to the efficient use of those resources.

Cost-of-illness and its determinants for type 2 diabetes mellitus in Bangladesh:

Background: Diabetes is one of the most prevalent non-communicable diseases (NCDs) all over the world and leading cause of death, disability, and economic loss. Diabetes imposes a heavy economic burden on individuals, their families and society as a whole. The aim of this study is to estimate the economic burden of type 2 diabetes mellitus (T2DM) in Bangladesh and to find association between glycemic control and Health Related Quality of Life with cost-of-illness (COI).
 Methodology: This will be an analytical cross-sectional cost-of-illness study. Within a specific time period participants aged ≥18 years, registered with Bangladesh Diabetic Somiti and having type 2 diabetes for more than one year will be recruited from selected hospitals inside and outside Dhaka to cover all level of health care services. A pre-tested electronic questionnaire will be used for data collection. The questionnaire will include demographic, clinical, behavioral information of the participants and all cost related information related to diabetes management during last one year. Descriptive statistics will include mean (±SD) or median (percentile) or relative frequencies (percentage) depending on the data. Two samples independent t-test or Mann-Whitney U-test, ANOVA or Kruskal-Wallis test and chi-squared tests will be used for univariate analysis. The multivariable regression analysis and bootstrap method will also be employed to analyze the relationship between the total cost of care (dependent variable) and several potential explanatory variables (independent variables). Logistic regression analysis will be performed to assess the factors affecting glycemic control and health related quality of life (HRQoL). The calculated total cost-of-illness will be projected for T2DM in Bangladesh by a mathematical modelling.
 Result & discussion: The results of the study will be useful as background information to forecast the economic burden of type 2 diabetes mellitus in Bangladesh and will be beneficial to conceptualize health strategies at national level. Furthermore, recognizing the factors of cost-of-illness will help both patients and health care providers to improve the management plan and cost control and hence, to have better quality of life. Evidence about the magnitude of the burden of T2DM is important for public health policymakers who are involved in making health care priorities and allocating scarce resources to facilitate the greatest benefits for type 2 diabetic people in Bangladesh.
 Bangladesh Journal of Medical Science Vol.18(3) 2019 p.501-507

Economic Burden of Type 2 Diabetes Mellitus among Patients in the Rural Field Practice Area of a Medical College in Davangere - A Cross Sectional Study

Background: Diabetes is rapidly emerging as a major health care problem, even in rural India. The earlier occurrence, delayed diagnosis and improper care leads to high complication rates, greater productivity loss and consequently higher costs. As the epidemiological burden of diabetes increases, the economic burden is expected to rise and the economically disadvantaged will be affected the most. Objectives: To assess the economic burden of diabetes among type 2 diabetic patients and to explore the factors associated with the economic burden of diabetes. Materials and Methods: Community based cross sectional study was carried out in rural field practice area of a medical college in Davangere for a period of six months during 2016-17 among 112 patients with type 2 diabetes mellitus. Information was collected using pretested predesigned questionnaire on socio-demographic details, health services utilization, expenditure incurred on diabetes care (both direct and indirect costs) in the past six months. Results: The direct cost accounted for 94.2% of the total cost of treatment, of which hospitalization for diabetes related complications and medications were major components. Source of health care significantly influenced the direct cost. About 8.9% of study subjects skipped medications at least once due to lack of money. Conclusions: Direct cost in the management of diabetes is major contributor to the expenditure. Availability of affordable essential quality diabetic medications and strengthening of public healthcare is crucial in reduction of these direct costs involved in diabetic management.

PDB9 - Characterizing the Clinical and Economic Burden of Type 2 Diabetes (T2DM) Patients on Multiple Daily Injections (MDI) of Insulin: A Systematic Literature Review

Evidence exists on demographics and costs of diabetes patients; however, data is limited on type 2 diabetes (T2DM) patients receiving a basal-bolus insulin regimen administered as multiple daily injections (>3 injections/day). The objective of the systematic literature review was to summarize the clinical and economic burden of T2DM patients using multiple daily injections (MDI) of insulin. A systematic literature review was conducted utilizing PubMed, the Cochrane library, and clinical trials.gov. Articles were included if they reported on clinical and/or economic burden of T2DM MDI patients. Articles were published after 1996, written in English. Key exclusions included: T1DM or mixed T1DM/T2DM populations (>10% T1DM); focus on non-insulin drugs or insulin pumps and studies enrolling <20 patients. Primary searches yielded 744 unique records, 330 full text articles were screened, and 66 met inclusion criteria. Fifty eight studies were primary observational (N=22) or interventional (N=36). Patients on insulin receiving >3 injections/day ranged from 23-36%. Mean demographic ranges included: age 49-73 years, weight 68-121kg, diabetes duration 6-17 years, and insulin duration 1-8 years. Comorbidities reported included hypertension (62-95%) and dyslipidemia (30-95%). Complications reported included neuropathy (29-59%) and retinopathy (19-22%). Total daily insulin doses ranged from 40-155 units/day; 0.7-2.4 U/kg/day. Mean baseline HbA1c ranged from 7.6-10.1% in observational and 6.9-10.3% in interventional studies. Patients achieving HbA1c <7% ranged from 8-16% in observational and 5-84% in interventional studies. Mean endpoint HbA1c ranged from 8.1-8.8% in observational; 6.4-8.6% in interventional studies. Total annual healthcare costs ranged from $20,553-$42,020; diabetes-related costs ranged from $8,180-$14,248. The findings of the systematic literature review suggest that T2DM patients on MDI had multiple comorbidities, microvascular complications, and substantial healthcare costs.

Incremental burden of type 2 diabetes in patients experiencing cardiovascular hospitalizations

Objective: To evaluate the incremental economic burden of type 2 diabetes in patients experiencing cardiovascular (CV) hospitalizations.Research design and methods: Adults with ≥1 CV hospitalization were identified using a US-based healthcare claims database from 1 July 2011 to 30 June 2014. Outcomes for patients surviving the index hospitalization were compared between patients with vs. without type 2 diabetes (cohorts were identified in the pre-index period). Subsequent CV hospitalizations were evaluated using Cox proportional hazards models. All-cause and CV-related healthcare resource utilization (HCRU) and costs captured on a per-patient per-month (PPPM) basis during a variable follow-up period were evaluated using appropriate multivariable regression models.Results: Of 316,207 patients with ≥1 CV hospitalization, 23% had comorbid type 2 diabetes. The mean age ± SD was 62.6 ± 12.3 years and 64.4% were male. During follow-up, the type 2 diabetes cohort had a 19% higher risk of subsequent CV hospitalizations compared to the non-type-2-diabetes cohort (p < .001). This difference in risk was highest in patients aged 35–44 years. Subsequent all-cause hospitalizations for the type 2 diabetes cohort were longer (mean length of stay, 6.7 vs. 6.3 days; p < .001), with higher total bed-days PPPM (mean, 0.52 vs. 0.43; p < .001), compared to the non-type-2-diabetes cohort. The type 2 diabetes cohort had a significantly higher incremental cost for both the index CV hospitalization (mean cost difference, $1046; p < .001) and all-cause costs PPPM following discharge (mean cost difference, $749; p < .001).Conclusions: Comorbid type 2 diabetes was associated with an increased risk of subsequent CV hospitalizations and higher costs and HCRU during the follow-up period.

Abstract # P-18: Economic Burden of Type 2 Diabetes Mellitus in Patients with Cardiovascular Disease in Commercially-Insured Patients in the United States

Abstract # P-18: Economic Burden of Type 2 Diabetes Mellitus in Patients with Cardiovascular Disease in Commercially-Insured Patients in the United States

The Physiological Effects of Dandelion (Taraxacum Officinale) in Type 2 Diabetes.

The tremendous rise in the economic burden of type 2 diabetes (T2D) has prompted a search for alternative and less expensive medicines. Dandelion offers a compelling profile of bioactive components with potential anti-diabetic properties. The Taraxacum genus from the Asteraceae family is found in the temperate zone of the Northern hemisphere. It is available in several areas around the world. In many countries, it is used as food and in some countries as therapeutics for the control and treatment of T2D. The anti-diabetic properties of dandelion are attributed to bioactive chemical components; these include chicoric acid, taraxasterol (TS), chlorogenic acid, and sesquiterpene lactones. Studies have outlined the useful pharmacological profile of dandelion for the treatment of an array of diseases, although little attention has been paid to the effects of its bioactive components on T2D to date. This review recapitulates previous work on dandelion and its potential for the treatment and prevention of T2D, highlighting its anti-diabetic properties, the structures of its chemical components, and their potential mechanisms of action in T2D. Although initial research appears promising, data on the cellular impact of dandelion are limited, necessitating further work on clonal β-cell lines (INS-1E), α-cell lines, and human skeletal cell lines for better identification of the active components that could be of use in the control and treatment of T2D. In fact, extensive in-vitro, in-vivo, and clinical research is required to investigate further the pharmacological, physiological, and biochemical mechanisms underlying the effects of dandelion-derived compounds on T2D.

Economic burden and catastrophic cost among people living with type2 diabetes mellitus attending a tertiary health institution in south-east zone, Nigeria.

BackgroundDiabetes mellitus (DM) is a life-long illness that affects the quality of life, requiring close monitoring and control. Type 2 DM is preventable and controllable but increasing cost of care could hinder access to quality care because of inability to pay leading to high morbidity, mortality and productivity losses. The people living with diabetes mellitus (PLWD) in Nigeria have high risk for high economic burden and catastrophic expenditure not only because they make frequent visits to the health facilities, report late with complications but also pay out of pocket at the point of accessing care. The aim of this study was to assess the magnitude of economic burden borne and catastrophic costs incurred by PLWD in Nigeria.MethodsCross-sectional descriptive survey design was used to study a sample of 308 type2 PLWD managed at a tertiary health institution, South east Nigeria using semi-structured, prevalidated questionnaire. Data collection period was 2 months.ResultsThe major findings were economic burden of type 2 DM of N56,245 ($356). Catastrophic direct cost was 45 % at 30 % threshold (the determinant level for catastrophic spending set). All socio-economic status (SES) groups suffered catastrophic expenditure but the poorest quartile had the highest incidence.ConclusionsEconomic burden of DM was high for PLWD who also suffered high catastrophic costs due to the impact of out of pocket payment. PLWD need financial protection especially for the poorest since they buy from the same market and incur same costs. Policy decision making to assist the PLWD cope with cost of care is needful in Nigeria and nations with related problems.

Economic Burden of Type 2 Diabetes Mellitus among the Patients Attending Combined Military Hospital, Dhaka

Introduction: Diabetes Mellitus (DM) is a major concern for the developed as well as developing countries. It poses with enormous disabilities and economic burden to the victims. The treatment cost of diabetes is increasing day by day. Aim: To ascertain how type 2 diabetes mellitus is incurring economic burden to the patients. Materials and Methods: This descriptive cross sectional study was conducted during the period from January to June 2010 on 110 type 2 diabetes mellitus patients attending Combined Military Hospital, Dhaka. The patients were selected conveniently and data were collected by face to face interview with the help of a semi-structured questionnaire. For estimation of economic burden, both direct and indirect treatment costs were calculated. Results: The study revealed that majority (36.4%) of the patients were in the age group of 46-55 years with the mean age of 53.65 (+10.44) years. Majority (60.0%) of them had lower monthly family income (Tk.5, 000-Tk.10, 000) and 36.4% of them lived in urban area. Most of the patients (90.9%) were under treatment with drug, diet control and physical exercise. Regarding sources of fund for treatment, 31.8% patients used their savings while 27.3% took loan, 20% got help from relatives and the remaining 20.9% got donation and sold wealth. Average treatment cost incurred by the patients was estimated to Tk. 5543.35 (+1273.29). Average direct treatment cost was estimated to Tk.2656.88 (+1367.23) of which average drug cost was Tk.653.36 (+476.36), investigation cost was Tk.596.73 (+375.56), travel cost Tk.530.31 (+795.46), attendant cost Tk.865.87 (+734.22) and consultation fee was Tk.244.48 (+167.22). Average indirect cost was calculated to Tk.3081.27 (+1275.91) which was only due to loss of income due to illness. Conclusion: The study findings will enable the health policy makers and health care providers at different levels to provide need based cost-effective health care services to reduce the economic burden of diabetes mellitus patients. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18718 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 8-13

Toll‐like receptors and NLRP3 as central regulators of pancreatic islet inflammation in type 2 diabetes

The global health and economic burden of type 2 diabetes (T2D) has reached staggering proportions. Current projections estimate that 592 million people will have diabetes by 2035. T2D-which comprises 90% of cases-is a complex disease, in most cases resulting from a combination of predisposing genes and an unhealthy environment. Clinical onset of the disease occurs when pancreatic β cells fail in the face of insulin resistance. It has long been appreciated that chronic activation of the innate immune system is associated with T2D, and many organs critical to the regulation of glucose homeostasis show signs of a chronic inflammatory process, including the pancreatic islets of Langerhans. Recent clinical trials using IL-1-targeting agents have confirmed that inflammation contributes to β-cell failure in humans with T2D. However, little is known about the nature of the pro-inflammatory response within the islet, and there is considerable debate about the triggers for islet inflammation, which may be systemically derived and/or tissue-specific. In this review, we present evidence that Toll-like receptors 2 and 4 and the NLRP3 (Nucleotide-binding oligomerization domain, Leucine-rich Repeat and Pyrin domain containing 3) inflammasome are triggers for islet inflammation in T2D and propose that the activation of macrophages by these triggers mediates islet endocrine cell dysfunction. Therapeutically targeting these receptors may improve hyperglycemia and protect the β cell in T2D.

Evaluating the Long-Term Cost-Effectiveness of Liraglutide Versus Exenatide BID in Patients With Type 2 Diabetes Who Fail to Improve With Oral Antidiabetic Agents

Background The global clinical and economic burden of type 2 diabetes is substantial. Recently, clinical trials with glucagon-like peptide-1 (GLP-1) receptor agonists (liraglutide and exenatide) have shown a multifactorial clinical profile with the potential to address many of the clinical needs of patients and reduce the burden of disease. Objective The goal of this study was to evaluate the long-term cost-effectiveness of once-daily liraglutide versus exenatide BID in patients with type 2 diabetes who failed to improve with metformin and/or sulfonylurea, based on the results of a previous clinical trial in 6 European countries (Switzerland, Denmark, Norway, Finland, the Netherlands, and Austria). Methods A validated computer simulation model of diabetes was used to predict life expectancy, quality-adjusted life years (QALYs), and incidence of diabetes-related complications in patients receiving liraglutide (1.8 mg once daily) or exenatide (10 μg BID). Baseline cohort characteristics and treatment effects were derived from the Liraglutide Effect and Action in Diabetes 6 trial. Country-specific complication costs were taken from published sources. Simulations were run over 40 years from third-party payer perspectives. Future costs and clinical benefits were discounted at country-specific discount rates. Sensitivity analyses were performed. Results Liraglutide was associated with improvements of 0.12 to 0.17 QALY and a reduced incidence of most diabetes-related complications versus exenatide in all settings. Evaluation of total direct medical costs (treatment plus complication costs) suggest that liraglutide was likely to cost between Euro (€) 1023 and €1866 more than exenatide over patients' lifetimes, leading to incremental cost-effectiveness ratios per QALY gained versus exenatide of: Switzerland, CHF (Swiss francs) 10,950 (€6902); Denmark, Danish krone [kr] 88,160 (€11,805); Norway, Norwegian krone [kr], 111,916 (€13,546); Finland, €8459; the Netherlands, €8119; and Austria, €8516. Conclusions Long-term projections indicated that liraglutide was associated with benefits in life expectancy, QALYs, and reduced complication rates versus exenatide. Liraglutide was cost-effective from a health care payer perspective in Switzerland, Denmark, Norway, Finland, the Netherlands, and Austria. Clinicaltrials.gov identifier: NCT 00518882.