台灣第二型糖尿病治療結果與不同糖化血色素指標分析

Abstract

第二型糖尿病患血糖狀況控制不穩定，常造成許多併發症的發生，特別是心血管疾病、視網膜病變、神經及腎臟病變，甚至嚴重導致死亡。伴隨糖尿病人口的成長，治療糖尿病及併發症的醫療費用，已經嚴重衝擊到個人與家庭經濟負擔，甚至影響整體醫療資源分配。本研究目的在初步探討以糖化血色素指標為介入措施，分析不同的治療目標值，對第二型糖尿病治療結果(Treatment outcome)，如：醫療利用（Medical utilization）、醫療費用(Medical expenditure)、平均餘命(Life expectancy)及生活品質調整後的平均餘命(Quality-adjusted life expectancy, QALE)之影響。本研究利用回溯性資料庫與電子病歷研究，以第二型糖尿病患的治療結果為參數值，依據病患糖化血色素控制狀況，使用電腦模擬模型進行40年治療結果模擬與經濟結果之預測。 研究結果顯示，當第二型糖尿病患維持HbA1c≦6.5%，預測所得之平均餘命為11.7年（10.1-13.2），轉換成生活品質調整後的平均餘命為9.0年（7.8-10.2），醫療費用預估699,216點（560,042-838,390）；當第二型糖尿病患維持HbA1c≦7.0%，預測所得之平均餘命為11.8年（10.5-13.1），轉換成生活品質調整後的平均餘命為9.1年（8.1-10.1），醫療費用預估748,616點（619,015-878,218），此模擬分析以糖化血色素≦6.5%與≦7.0%之預測結果，最符合臨床治療標準之建議。本研究結果可提供臨床治療者更快速掌握決策要點，針對第二型糖尿病患病情發展，提供更合適並且符合經濟效用之健康照護計畫。

Glycemic control will be appropriate for type 2 diabetes patients who are experienced of severe complications. With an increasing shift of medical costs to diabetic complications, medical care obligations increase demands on the treatment. However, the financial impact on third party payers is quite intense as a result of circumstance. This study was estimated the cost utility of treatment outcome with glycemic control in Taiwan. A published diabetes computer model (the UKPDS Outcome Model) was used to simulate clinical and economic outcomes of type 2 diabetes patients with different HbA1c targets. Patient outcomes included medical utilization, medical expenditure, life expectancy and quality-adjusted life expectancy (QALE). The economic analysis was performed from a third payer perspective for 40 years. The simulation results assume if HbA1c≦6.5%, mean life expectancy will estimate by 11.7 years per patient (10.1-13.2) and mean QALE by 9.0 years per patient (7.8-10.2). It will associate with a medical direct cost of insurance credit 699,216 (560,042-838,390). In addition, HbA1c ≦7.0%, mean life expectancy will estimate by 11.8 years per patient (10.5-13.1) and mean QALE by 9.1 years per patient (8.1-10.1). Final direct cost of insurance credit will increase to 748,616 (619,015-878,218). Although inappropriate HbA1c goals were projected to increase medical costs, therefore HbA1c target ≦6.5% or≦7.0% may be beneficial to patients with life expectancy at least longer. This pilot study previewed the treatment outcome with different HbA1c targets, which can be utilized in health care management.