E-postama gönder İSTANBUL İLİNDE ÜÇ HASTANEDE AYAKTAN İZLENEN TİP II DİYABETİK HASTALARDA GLİSEMİK KONTROLÜN MALİYET ETKİNLİĞİNİN DEĞERLENDİRİLMESİ - THE COST EFFECTIVENESS of GLYCEMIC CONTROL in TYPE II DIABETIC PATIENTS UNDER FOLLOW-UP in THREE HOSPITALS in ISTANBUL
Öz
Diyabet gittikçe artan maliyete sahip bir kronik hastalıktır. Diyabetin kontrol ve tedavisinde en önemli hedef ise glisemik kontroldür. Araştırmanın amacı; İstanbul’da hizmet veren üç ayrı hastanede ayaktan izlenen tip II diyabetik hastalarda glisemik kontrol için kullanılan tedavilerin maliyet etkililiğinin değerlendirilmesidir. Araştırma, İstanbul’da devlet, üniversite ve özel olmak üzere üç ayrı hastaneye kontrol için başvuran en az altı aylık tanılı 392 tip II diyabet hastası ile yürütülmüş bir maliyet-etkililik araştırması idi. Veriler, araştırmacılar tarafından hazırlanan iki bölümden oluşan bir anket formu uygulanarak toplandı. Maliyet etkililik analizinde her hastane için alınan tedavi türüne göre toplam maliyet ve etkililik hesaplandı. İstatistiksel analizler SPSS paket programında tanımlayıcı istatistikler ve X2 testi kullanılarak değerlendirildi. Değişkenlerin birlikte glisemik kontrolün toplam maliyetinin ne kadarını açıkladığını belirlemek amacıyla çoklu regresyon analizi kullanıldı. Araştırmaya katılan hastaların %59.2’sinin HgbA1c düzeyleri normaldi ve hastaneler arasında hastaların HgbA1c düzeyleri açısından istatistiksel olarak anlamlı fark bulundu (p<0.001). Çoklu regresyon analizinde; başvurulan hastane, hastalığın süresi, alınan tedavi türü, hastanın BKİ ve HgbA1c değeri glisemik kontrolün toplam maliyetini arttıran faktörler olarak, diyet listesini uygulama durumu ise maliyeti azaltan faktör tespit edildi. Ayrıca analiz sonucunda başvurulan hastane göreli olarak en önemli değişken olarak bulundu. Oral antidiyabetik (OD) tedavi için ise, üniversite hastanesi maliyet etkililik açısından maliyeti düşük ve etkililiği yüksek olarak bulundu ve maliyet-etkililik analizinde kabul sonucu saptandı. Tip II diyabetik hastalardaki tedavilerin etkinliği ve maliyeti her üç hastanedeki poliklinik uygulamaları açısından karşılaştırılmış ve farklı bulunmuştur.
Anahtar Kelimeler: Diabetes mellitus, Hastane, Maliyet, Maliyet etkililik
THE COST EFFECTIVENESS OF GLYCEMIC CONTROL IN TYPE II DIABETIC
PATIENTS UNDER FOLLOW-UP IN THREE HOSPİTALS IN ISTANBUL
Abstract:
Diabetes mellitus is a chronic disease with increasing health costs. The major target in the control and treatment of diabetes is the glycemic control. The aim of this study was to evaluate the cost-effectiveness of glycemic control in type II diabetic patients under follow-up in three hospitals in Istanbul. This is a cost-effectiveness study conducted on 392 patients with a diagnosis of type II diabetes for at least 6 months who were under follow-up in a total of three
state, university and private hospitals in Istanbul. Data were collected by using a two-section questionnaire form prepared by the researchers. Cost-effectiveness is analyzed by calculating the total cost and effectiveness by the treatment method in each hospital. Statistical analysis was performed on SPSS package program and by using descriptive statistics and X2 test. Multiple regression analysis was used to determine whether the variables can explain the total
cost of glycemic control. The HbA1c level was normal in 59.2% of the participants and differed significantly between the patients from different hospitals (p<0.001). Multiple regression analysis revealed the factors increasing the cost as the hospital admitted, disease duration, treatment type, BMI and HBA1c level, while the factor decreasing the cost was compliance to the diet list. Importantly, the relatively most significant variable was the hospital admitted. For the treatment with oral antidiabetics (OD), university hospitals had the least cost and highest effectiveness with an acceptable cost-effectiveness. Effectiveness and cost of the therapy in Type II diabetic patients were compared and found to be different between the outpatient clinics in three hospitals.
Key words: Diabetes mellitus, Hospital, Cost, Cost-effectiveness
Tam Metin:
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