Cost effectiveness of glysemic control in three different hospital outpatient clinics in Istanbul

Introduction. In this research were aimed to assess the cost effectiveness of type 2 diabetes patients glysemic control therapies. Methods. Cost effectiveness analysis, and the study was conducted public, private and university hospitals in Istanbul.  392 type 2 diabetics were included to the study. Drugs, glucometric devices, laboratory tests, outpatient control costs, specialist doctor and nurse salaries, and patient training costs are included  to the total costs of glycemic control. HgbA1c levels were used for the calculation of effectivenes. State hospital was taken control for incremental cost-effectiveness calculation.

Findings. Insulin theraphy per capita costs (pcc) and effectivenes (eff) values were as follows: 316.05 TL pcc, 3.62 eff  in the state hospital; 323.44 TL pcc, 10.94 eff  in the university hospital;  562.70 TL pcc, 5.32 eff in the private hospital.  The incremental cost ratios were 1 and 123 in the university and private hospital respectively. Oral antidiabetic therapy pcc and eff values were as follows:  pcc; 228.38 TL eff; 3.48 in the state hospital,  pcc; 213.56 TL eff; 10.74 in the  university hospital, and  pcc;465.45 TL, eff; 9.47 in the private hospital. Oral antidiabetic therapy, incremental cost ratios for the university hospital and private hospital were -2 and 40 respectively. Mixed therapy pcc; 347.25 TL, eff; 3.46 in the state hospital, pcc; 400.60 TL, eff; 3.23 in the university hospital, pcc; 620.72 TL, eff; 7.12 in the private hospital. Mixed therapy, incremental cost ratios for the university hospital and private hospital were 3 and 17 respectively. In multivariate analysis diet list practicing was found to be a significant cost decreasing factor.

Conclusion. Only the oral antidiabetic therapy in the university hospital was found to be cost effective. Costs effective therapy schemes should be regulated for all hospitals. and disease management activities and behavioural therapies should be implemented in hospitals.