Niveles de hemoglobina glicosilada y diferencia en el gasto en salud de pacientes diabéticos: un estudio econométrico / Levels of glycosylated hemoglobin and the difference in the cost of health care for diabetic patients: an econometric study

Background: Complications increase treatment costs of diabetes mellitus (DM). An adequate metabolic control of the disease could reduce these costs. Aim: To evaluate the costs of medical care for a cohort of patients with DM, according to their degree of metabolic compensation. Material and Methods: All diabetic patients attended in a regional hospital from 2005 to 2010 were analyzed. A correlational study between costs of individual healthcare and levels of glycosylated hemoglobin (HbA1c), was performed in a series of annual cross-sectional measurements. Results: The study comprised 1,644 diabetic patients. During the study period the average cost of healthcare per patient increased from $878,000 to more than $1,000,000 Chilean pesos (CLP) during the study period. The percentage of patients with HbA1c levels below 7.0% varied between 43.0% and 54.9%. Costs for patients with HbA1c levels between 7 and 8.9% were 1.3 to 1.5 times greater. For the group of patients with HbA1c levels between 9 and 10.9% the costs increased 1.4 to 1.6 times. For patients with HbA1c levels greater than 11.0%, healthcare costs doubled. Conclusions: Healthcare expenditure varied according to metabolic control, which is consistent with international findings. This study was limited by its selected population, incomplete information on health expenditures, and the inclusion of only direct costs to the health system. If all patients would achieve metabolic compensation, the yearly savings would be CLP $308,000,000 (or USD $657,000).

Influencia de la obesidad en los costos en salud y en el ausentismo laboral de causa médica en una cohorte de trabajadores / Influence of obesity on health care costs and absenteeism among employees of a mining company

Background: The health associated costs of obesity can represent between 2 percent and 9 percent of the total health costs of a given country. Aim: To assess the impact of obesity on health care costs and absenteeism in a cohort of mine workers. Patients and wethods: Prospective study of 4.673 men, employees of a mining company, aged 49 ± 7 years that were followed for 24 ± 11 months. Total health care cost and days of sick leave were recordedfor each individual. The association between obesity and these variables was analyzed by logistic regression adjusting for co-morbidities, age and other variables. Results: Mean annual health care costs for obese workers were 17 percent higher (p <0.001) compared to workers with normal weight and 58 percent higher (p <0.001) for workers with severe and morbid obesity. Mean annual days of sick leave increased by 25 percento in the obese (p =0.002) and by 57 percento in subjects with severe and morbid obesity (p <0.001). For health care costs the most significant predictors were: presence of diabetes mellitus (Odds ratio (OR) 6.21, 95 percento confidence intervals (95 percent CI) 4.9 to 7.9), hypertension (OR 3-99; 95 percent CI3-4 to 4.6) and severe and morbid obesity (OR 2.55, 95 percento CI 1.9 to 3-4). For absenteeism the most significant predictors were: presence of diabetes mellitus (OR 1.58, 95 percent> CI 1.2 to 2.0), hypertension (OR 1,34, 95 percent> CI 1.2 to 1.6) and severe and morbid obesity (OR 1.50, 95 percento CI 1.1 to 2.1). Conclusions: Obesity increases significantly health care costs and absenteeism.