Diabetes & Metabolism Journal

Original Articles

An Analysis of Medical Costs of Diabetic Patients in a University Hospital (1996~2005).: Ki Hong Chun, Kwan Woo Lee, Dae Jung Kim, Hae Jin Kim, Kyung Won Paek, Soo Jin Lee; Korean Diabetes J. 2008;32(4):366-376. Published online August 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.4.366

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BACKGROUND
The aim of this research was to find out the costs of diabetes, as research in a prospective cohort study looking into the development of diabetic complications followed by treatment intervention by a medical institution. The research compared the changes in medical costs by following-up on the treatment details of diagnosed diabetes for the last 10 years in a university hospital. METHODS: The research used data of outpatient, inpatient, pharmaceutical and total medical costs, from 1996 to 2005, of individual patients who were diagnosed with diabetic patients, to analyze the outpatient and inpatient total medical cost changes over the years. RESULTS: After antidiabetic drug, in the case of outpatient treatment, pharmaceutical costs increased on average by about 25,000 won a month for diabetic patients without complications and by 35,000 won for diabetic patients with microvascular complications. Outpatient medical costs were affected after drug treatment by as much of an increase as created by the pharmaceutical costs. The total medical costs, that is the sum of inpatient and outpatient costs, decreased by 30~40% compared to that before drug treatment. In the case of total medical cost, MI or ESRD cost 2~3 times more in pharmaceutical costs than before the development of complications. The total medical costs of diabetic patients with CVA, MI and ESRD complications increased in the first year after development of the complication, and this was followed by a decrease in the next year, showing a tendency to remain constant with no increase or decrease over subsequent years. This means that the total medical costs of patients with complications remain continuously large throughout the life of the diagnosed patient. CONCLUSION: For diabetic patients, pharmaceutical costs are the most important factor in determining outpatient medical costs.

Citations

Citations to this article as recorded by

Outcome Research in Diabetes
Kwan Woo Lee
Journal of Korean Diabetes.2011; 12(1): 2. CrossRef
Costs of Diabetes Mellitus in Korea
Kwan Woo Lee
Diabetes & Metabolism Journal.2011; 35(6): 567. CrossRef

Clinical Characteristics and Direct Medical Costs of Type 2 Diabetic Patients.: Eun Joon Moon, Young Eun Jo, Tae Chin Park, Yun Kyung Kim, Sun Hye Jung, Hae Jin Kim, Dae Jung Kim, Yoon Sok Chung, Kwan Woo Lee; Korean Diabetes J. 2008;32(4):358-365. Published online August 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.4.358

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Abstract PDF

BACKGROUND
Type 2 diabetes mellitus is an expensive chronic metabolic disorder and its prevalence has been increasing rapidly in South Korea, owing to a westernized lifestyle. We analyzed the annual direct medical costs attributable to type 2 diabetes and its chronic complications in Korea retrospectively. METHODS: We randomly selected 1,051 patients with type 2 diabetes who visited Ajou University Hospital as an outpatient in 2005. Clinical characteristics, duration of diabetes, and microvascular and macrovascular complications were assessed from a medical chart review. The annual direct medical costs included insurance covered and uncovered medical costs. RESULTS: Of the 1,051 patients with type 2 diabetes, 48.2% had at least one microvascular complication, 5.6% had at least one macrovascular complication, and 12.4% of the patients had both microvascular and macrovascular complications. The average annual direct medical cost was found to be 3,348,488won per patient. In patients with microvascular complications, the total cost of management was increased 1.4 times compared to those without complications. Direct medical costs for patients with macrovascular complications were 2.1-fold as high as patients with no complications. Those patients with both microvascular and macrovascular complications, increased costs by 3.1-fold over those without complications. CONCLUSION: Chronic complications have a substantial impact on the direct medical costs of type 2 diabetes. The prevention of chronic diabetic complications will not only influence the mortality and morbidity of patients with type 2 diabetes, but also potentially reduce medical costs.

Citations

Citations to this article as recorded by

Importance of family history of diabetes in computing a diabetes risk score in Korean prediabetic population
Morena Ustulin, Sang Youl Rhee, Suk Chon, Kyu Keung Ahn, Ji Eun Lim, Bermseok Oh, Sung-Hoon Kim, Sei Hyun Baik, Yongsoo Park, Moon Suk Nam, Kwan Woo Lee, Young Seol Kim, Jeong-Taek Woo
Scientific Reports.2018;[Epub] CrossRef
Features of Long-Standing Korean Type 2 Diabetes Mellitus Patients with Diabetic Retinopathy: A Study Based on Standardized Clinical Data
Sejeong Park, Sang Youl Rhee, Su Jin Jeong, Kiyoung Kim, Suk Chon, Seung-Young Yu, Jeong-Taek Woo
Diabetes & Metabolism Journal.2017; 41(5): 393. CrossRef
Association between Sleep Duration and Impaired Fasting Glucose in Korean Adults: Results from the Korean National Health and Nutrition Examination Survey 2011–2012
Cho-Rong Kim, Yun-Mi Song, Jin-Young Shin, Wook Gim
Korean Journal of Family Medicine.2016; 37(1): 51. CrossRef
Trends in the Diabetes Epidemic in Korea
Kyoung Hwa Ha, Dae Jung Kim
Endocrinology and Metabolism.2015; 30(2): 142. CrossRef
Economic Evaluation of Diabetes Education
Jin-Won Noh, Young Dae Kwon, Jin-Hee Jung, Kang Hee Sim, Hee-Sook Kim, Minjae Choi, Jumin Park
The Journal of Korean Diabetes.2015; 16(4): 293. CrossRef
Association between diabetes-related factors and clinical periodontal parameters in type-2 diabetes mellitus
Eun-Kyong Kim, Sang Gyu Lee, Youn-Hee Choi, Kyu-Chang Won, Jun Sung Moon, Anwar T Merchant, Hee-Kyung Lee
BMC Oral Health.2013;[Epub] CrossRef
Cytoprotective Effect of Ethanol Extract from Maesil (Prunus mume Sieb. et Zucc.) on Alloxan-induced Oxidative Damage in Pancreatic-cell, HIT-T15
In-Hye Kim, Jong-Bae Kim, Kang-Jin Cho, Jae-Hyun Kim, Ae-Son Om
Korean Journal of Plant Resources.2012; 25(2): 184. CrossRef
The Protective Effects of Chrysanthemum cornarium L. var. spatiosum Extract on HIT-T15 Pancreatic β-Cells against Alloxan-induced Oxidative Stress
In-Hye Kim, Kang-Jin Cho, Jeong-Sook Ko, Jae-Hyun Kim, Ae-Son Om
The Korean Journal of Food And Nutrition.2012; 25(1): 123. CrossRef
Outcome Research in Diabetes
Kwan Woo Lee
Journal of Korean Diabetes.2011; 12(1): 2. CrossRef
Costs of Diabetes Mellitus in Korea
Kwan Woo Lee
Diabetes & Metabolism Journal.2011; 35(6): 567. CrossRef
The Epidemiology of Diabetes in Korea
Dae Jung Kim
Diabetes & Metabolism Journal.2011; 35(4): 303. CrossRef
The Hypoglycemic Effect of Complex of Chinese Traditional Herbs (CTH) and Macelignan in Type 2 Diabetic Animal Model

Journal of Life Science.2010; 20(7): 1113. CrossRef
Epidemiologic Characteristics of Diabetes Mellitus in Korea: Current Status of Diabetic Patients Using Korean Health Insurance Database
Ie Byung Park, Sei Hyun Baik
Korean Diabetes Journal.2009; 33(5): 357. CrossRef
Management of Diabetic Mellitus in Low-income Rural Patients
Hye-Yeon Kim, Woo-Jun Yun, Min-Ho Shin, Sun-Seong Kweon, Hye-Ran Ahn, Seong-Woo Choi, Young-Hoon Lee, Dong-Hyeok Cho, Jung-Ae Rhee
Journal of Preventive Medicine and Public Health.2009; 42(5): 315. CrossRef
Prevalence of Pancreatic Cancer in Diabetics and Clinical Characteristics of Diabetes-associated with Pancreatic Cancer - Comparison between Diabetes with and without Pancreatic Cancer -
Seung Goun Hong, Jae Seon Kim, Sung Joo Jung, Moon Kyung Joo, Beom Jae Lee, Jong Eun Yeon, Jong-Jae Park, Kwan Soo Byun, Young-Tae Bak
The Korean Journal of Gastroenterology.2009; 54(3): 167. CrossRef

Direct Medical Costs of Type 2 Diabetic Patients in the Tertiary Hospital.: Joo An Hwang, Tae Chin Park, Sun Hye Jung, Hae Jin Kim, Dae Jung Kim, So Hun Kim, Moon Suk Nam, Tae Hyun Kim, Moon Kyu Lee, Kwan Woo Lee; Korean Diabetes J. 2008;32(3):259-268. Published online June 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.3.259

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Abstract PDF

BACKGROUND
Type 2 diabetes mellitus is a common, chronic and costly disease. Its prevalence is rapidly increasing worldwide. Diabetes has big economic burden mainly because of its chronic complications. We analyzed the annual direct medical costs of type 2 diabetic patients, including the costs associated with its complications in Korea retrospectively. METHODS: We enrolled 531 type 2 diabetic patients who had been treated in the 3 Tertiary Hospital in 2005. Clinical characteristics, duration of diabetes, modality of glycemic control, and presence of microvascular and macrovascular complications were assessed by the review of medical records. The annual direct medical costs were assessed using the hospital electronic database and included insurance covered and uncovered medical costs. RESULTS: The annual direct medical costs of type 2 diabetic patients without any complications was 1,184,563 won (95% CI for mean: 973,006~1,396,121 won). Compared to diabetic patients without complications, annual total medical costs increased 4.7-fold, 10.7-fold, and 8.8-fold in patients with microvascular complications, macrovascular complications and both complications, respectively. Hospitalization costs largely increased by 78.7-fold and 61.0-fold in patients with macrovascular complications and both complications, respectively. Major complications to increase medical costs were kidney transplantation (23.1-fold), dialysis (21.0-fold), PTCA or CABG (12.4-fold), and leg amputation (11.8-fold). The total medical costs dramatically increased according to the stage of diabetic retinopathy and nephropathy. CONCLUSION: Diabetic complications have a substantial impact on the direct medical costs of type 2 diabetic patients. The prevention of diabetic complications will benefit the patients as well as the overall healthcare expenditures.

Citations

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Policy Proposals for Infection Control in Patients with Chronic Wounds
Kyung-Chul Moon, Donghyeok Shin, Kyu-Won Baek, Changsik John Pak, Young-Joon Jun
Journal of Wound Management and Research.2022; 18(3): 249. CrossRef
Effects of Co‐administration of Sulfonylureas and Antimicrobial Drugs on Hypoglycemia in Patients with Type 2 Diabetes Using a Case‐Crossover Design
Sera Lee, Miyoung Ock, Hun‐Sung Kim, Hyunah Kim
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy.2020; 40(9): 902. CrossRef
The effect of continuity of care on the incidence of end-stage renal disease in patients with newly detected type 2 diabetic nephropathy: a retrospective cohort study
Yun Jung Jang, Yoon Soo Choy, Chung Mo Nam, Ki Tae Moon, Eun-Cheol Park
BMC Nephrology.2018;[Epub] CrossRef
Social Welfare Information for Patients with Diabetes Mellitus
Jea Yeon Lee
The Journal of Korean Diabetes.2016; 17(2): 117. CrossRef
Hypoglycemia and Health Costs
Yong-ho Lee, Gyuri Kim, Eun Seok Kang
The Journal of Korean Diabetes.2016; 17(1): 11. CrossRef
Outcome Research in Diabetes
Kwan Woo Lee
Journal of Korean Diabetes.2011; 12(1): 2. CrossRef
Costs of Diabetes Mellitus in Korea
Kwan Woo Lee
Diabetes & Metabolism Journal.2011; 35(6): 567. CrossRef
How Much Amount of Socioeconomic Loss Is Caused by Digestive Diseases?
Kyung Sik Park
The Korean Journal of Gastroenterology.2011; 58(6): 297. CrossRef

Current Status of the Continuity of Ambulatory Diabetes Care and its Impact on Health Outcomes and Medical Cost in Korea Using National Health Insurance Database.: Jaiyong Kim, Hyeyoung Kim, Hwayoung Kim, Kyung Wan Min, Seok Won Park, Ie Byung Park, Jeong Hyun Park, Sei Hyun Baik, Hyun Shik Son, Chul Woo Ahn, Jee Young Oh, Sunhee Lee, Juneyoung Lee, Choon Hee Chung, Kyung Mook Choi, Injeoung Choi, Dae Jung Kim; Korean Diabetes J. 2006;30(5):377-387. Published online September 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.5.377

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48 Download
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Abstract PDF

BACKGROUND
The continuity of care in chronic diseases, especially in diabetes, was emphasized from many studies. But large scale studies with long-term observation which confirm the impact of continuity of care on health outcomes are rare. This study tried national level 3 year observation to find differences in hospitalization, mortality and medical costs among patient groups with different utilization pattern. METHODS: The 1,088,564 patients with diabetes diagnosis and diabetes drug prescription in 2002, from 20 to 79 years old, and survived until the end of 2004 were included. Annual drug prescription days, number of visited clinics and quarterly continuity of care were measured. Gender, age group, living area, health insurance premium level (as a proxy of the income level), years of first DM diagnosis, five co-morbidities (hypertension, heart disease, stroke, renal disease, admission with DM), hospitalization experience and the type of main attending clinic were adjusted. Hospitalization, mortality and high costs group (top quintile) in 2005 were predicted by multiple logistic regression model. RESULTS: Patients who failed in continuity of care in 2003 and 2004 showed higher hospitalization (OR =1.29), higher mortality (OR =1.75) and they are more likely to be high costs group (OR =1.34) in 2005 than who fulfilled the continuity of care. Patients who have single attending clinic also showed lower hospitalization, lower mortality and lower cost. Completeness in diabetic drug prescription were correlated with lower hospitalization, lower mortality but with higher cost. Possible cost saving from continual care with single attending clinic was estimated at Won 417 billion (Dollar 1 = Won 943.7). Possible expenditure from complete drug prescription was Won 228 billion. So, net saving was Won 139 billion in our study population. CONCLUSION: Continual care and single attending clinic saves patient's life and national costs. Fragmented primary care system in Korea should be reformed for more effective care of chronic diseases. National Health Insurance Database in Korea enables nationwide long-term observation study which overcomes the many limitations found in hospital-based studies and cross-sectional surveys.

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Impact of Continuous Care on Health Outcomes and Cost for Type 2 Diabetes Mellitus: Analysis Using National Health Insurance Cohort Database
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Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea
Sanghyun Cho, Ji-Yeon Shin, Hyun Joo Kim, Sang Jun Eun, Sungchan Kang, Won Mo Jang, Hyemin Jung, Yoon Kim, Jin Yong Lee
Journal of Korean Medical Science.2019;[Epub] CrossRef
Evaluation of the chronic disease management program for appropriateness of medication adherence and persistence in hypertension and type-2 diabetes patients in Korea
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Medicine.2017; 96(14): e6577. CrossRef
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Young Soon Nam, Kyoung Hee Cho, Hee-Chung Kang, Kwang-Sig Lee, Eun-Cheol Park
Health Policy.2016; 120(6): 604. CrossRef
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Kyoung Hee Cho, Eun-Cheol Park, Young Soon Nam, Seon-Heui Lee, Chung Mo Nam, Sang Gyu Lee, Saravana Kumar
PLOS ONE.2016; 11(3): e0150926. CrossRef
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Clinical and Experimental Hypertension.2016; 38(8): 701. CrossRef
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Chi Heon Kim, Chun Kee Chung, Sukyoun Shin, Bo Ram Choi, Min Jung Kim, Byung Joo Park, Yunhee Choi
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Current Status of Diabetic Foot in Korean Patients Using National Health Insurance Database.: Choon Hee Chung, Dae Jung Kim, Jaiyong Kim, Hyeyoung Kim, Hwayoung Kim, Kyung Wan Min, Seok Won Park, Jeong Hyun Park, Sei Hyun Baik, Hyun Shik Son, Chul Woo Ahn, Jee Young Oh, Sunhee Lee, Juneyoung Lee, Kyung Mook Choi, Injeoung Choi, Ie Byung Park; Korean Diabetes J. 2006;30(5):372-376. Published online September 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.5.372

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Abstract PDF

BACKGROUND
Foot ulcer diseases are more prevalent in diabetic patients than that those of non-diabetic patients. Several reports showed the risk of amputation and the medical cost were increased when foot ulcer developed. Therefore, strict glycemic control from the initial period of diabetes is necessary. Since there is no enough epidemiologic data, large scaled studies for medical and economic consequences about diabetic foot ulcer are needed. METHODS: This study was based on health insurance claims submitted to the National Health Insurance Review Agency during the period from December 1994 through December 2002. We investigated the incidence and medical cost of foot disorders in Korean population using the disease-classification codes on the health insurance claim forms. RESULTS: The incidences of foot disorders (per 100,000 of population) were 49.7 for amputations, 99.7 for ulcers, and 1,051 for injuries in diabetic patients, and 4.2 for amputations, 10.3 for ulcers, and 943 for injuries in non-diabetic patients. Relative risk of the incidences of foot amputation, ulcer, and injury in diabetic patients comparing with non-diabetic patients were 11.7, 9.7, and 1.1, respectively. Total medical costs (per capita) of foot amputation, ulcer, and injury in diabetic patients were 2.0, 1.7, and 2.1 times higher, respectively, than those of non-diabetic patients. Mean hospital stay of foot amputation, ulcer, and injury in diabetic patients were 1.6, 1.3, and 1.7 times more, respectively, than those of non-diabetic patients. CONCLUSION: In diabetic patients, the incidences of foot amputation and ulcer are higher than those of non-diabetic patients. To reduce those incidences, we need to early strict glycemic control as well as government based management.

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