Annual direct medical costs associated with diabetes-related complications in the event year and in subsequent years in Hong Kong

AIM

To develop models to estimate the direct medical costs associated with diabetes-related complications in the event year and in subsequent years.

METHODS

The public direct medical costs associated with 13 diabetes-related complications were estimated among a cohort of 128 353 people with diabetes over 5 years. Private direct medical costs were estimated from a cross-sectional survey among 1825 people with diabetes. We used panel data regression with fixed effects to investigate the impact of each complication on direct medical costs in the event year and subsequent years, adjusting for age and co-existing complications.

RESULTS

The expected annual public direct medical cost for the baseline case was US$1,521 (95% CI 1,518 to 1,525) or a 65-year-old person with diabetes without complications. A new lower limb ulcer was associated with the biggest increase, with a multiplier of 9.38 (95% CI 8.49 to 10.37). New end-stage renal disease and stroke increased the annual medical cost by 5.23 (95% CI 4.70 to 5.82) and 5.94 (95% CI 5.79 to 6.10) times, respectively. History of acute myocardial infarction, congestive heart failure, stroke, end-stage renal disease and lower limb ulcer increased the cost by 2-3 times. The expected annual private direct medical cost of the baseline case was US$187 (95% CI 135 to 258) for a 65-year-old man without complications. Heart disease, stroke, sight-threatening diabetic retinopathy and end-stage renal disease increased the private medical costs by 1.5 to 2.5 times.

CONCLUSIONS

Wide variations in direct medical cost in event year and subsequent years across different major complications were observed. Input of these data would be essential for economic evaluations of diabetes management programmes.

Home blood pressure monitoring--a trial on the effect of a structured education program

BACKGROUND

This study aimed to assess whether a structured home blood pressure monitoring (HBPM) education program can improve blood pressure control in patients.

METHODS

A cluster randomised controlled trial in which half of 240 patients in the intervention group received an education program focused on using HBPM machines at home, while the other half had the usual care. The primary endpoints were mean systolic blood pressure and diastolic blood pressure.

RESULTS

Systolic blood pressure dropped 1.88 mmHg (p=0.372) and diastolic blood pressure significantly dropped 3.84 mmHg (p=0.004) in intervention group at 3 months. At 6 months, systolic blood pressure and diastolic blood pressure were still on a decreasing trend, but there was no significant difference in blood pressure changes between the two groups.

DISCUSSION

The structured HBPM education program has the potential to improve patient blood pressure control at short term, but such effect appears tailing off at medium terms. Additional components may be needed to maximise and sustain the benefit of HBPM.