臨床醫(yī)學(xué)治療糖尿病成本研究課件

1、CODIC-CODIC-中國(guó)大城市治療中國(guó)大城市治療2 2型糖尿病及其并發(fā)癥的成本研究型糖尿病及其并發(fā)癥的成本研究CODIC - Cost of Treating Type2 Diabetes & complications in urban China研究范圍研究范圍Study definition只包括省會(huì)城市只包括省會(huì)城市Only Provincial Capital cities are included 主要內(nèi)容主要內(nèi)容 Topics糖尿病流行病學(xué)糖尿病流行病學(xué)Epidemiology of diabetes mellitusCODIC方法學(xué)方法學(xué)CODIC methodol

2、ogyCODIC項(xiàng)目糖尿病人口學(xué)特征項(xiàng)目糖尿病人口學(xué)特征Demographics of diabetic patients in CODIC2 2型糖尿病病人疾病負(fù)擔(dān)型糖尿病病人疾病負(fù)擔(dān)Disease burden of patients with type 2 diabetes糖尿病的流行病學(xué)特征糖尿病的流行病學(xué)特征Diabetes Epidemiology1995-2025年間，全球糖尿病患者已由1.35億增長(zhǎng)到3.0億，表明糖尿病患病率將增長(zhǎng)27%，一般成年人群的預(yù)期增長(zhǎng)率為11%Globally, the number of people with diabetes will incr

3、ease from 135m to 300m between 1995-2025. This represents a 27% increase in diabetes prevalence, compared to expected 11% increase in general adult population.全球2型糖尿病病例占所有糖尿病的90%(中國(guó)為95%)Type2 diabetes accounts for 90% of diabetes cases world-wide (In China - 95%)Diabetes Care (1998) 21:1414-1431Diab

4、etologica (2002) 45:SI-S4China Pharmaceutical Report Vol. 7, No. 4ISIS Diabetic Therapy Monitor,(2000-2002) PhV-VI中國(guó)中國(guó)2型糖尿病患病率型糖尿病患病率Type2 Diabetes prevalence in China中國(guó)糖尿病的患病率估計(jì)為3.21%Diabetes prevalence in China is estimated at 3.21% 中國(guó)城市地區(qū)的患病率估計(jì)為4.8%Prevalence in urban China is estimated at 4.8% 武

5、漢、沈陽(yáng)和西安，采用全國(guó)的糖尿病患病率4.8%For Wuhan, Shenyang and Xian, diabetes the national prevalence of 4.8% was used總?cè)巳褐校?0%的患者確診Of those with diabetes, 30% are diagnosed. 確診糖尿病病人中，40%得到治療Of the diagnosed diabetic population, 40% are treated.China Pharmaceutical Report Vol. 7, No. 4ISIS Diabetic Therapy Monitor,

6、Ph5 & 6中國(guó)城市中國(guó)城市2型糖尿病患病率型糖尿病患病率Prevalence of Type2 Diabetes in urban cities in China 城市（城市（CITY）患病率（患病率（Prevalence）北京（Beijing）6.24%成都（Chengdu）5.16%武漢（Wuhan）4.80%沈陽(yáng)（Shenyang）4.80%西安（Xian）4.80%上海（Shanghai）4.60%濟(jì)南（Jinan）4.38%廣州（Guangzhou）3.86%重慶（Chongqing）3.70%南京（Nanjing）3.22%杭州（Hangzhou）2.34%Epidem

7、iology series for 21st Century, Aug2000, 4th version, Peoples Healthcare Publishing houseChina Pharmaceutical Report Vol. 7, No. 42型糖尿病型糖尿病并發(fā)癥并發(fā)癥Type2 Diabetes complications2 2型糖尿病型糖尿病并發(fā)癥對(duì)許多器官系統(tǒng)有直接損害，尤其并發(fā)癥對(duì)許多器官系統(tǒng)有直接損害，尤其是長(zhǎng)期并發(fā)癥，導(dǎo)致發(fā)病率和死亡率升高是長(zhǎng)期并發(fā)癥，導(dǎo)致發(fā)病率和死亡率升高Type2 Diabetes complications can have a dire

8、ct detrimental effects to many organ systems, with significant long-term complications and impact on morbidity and mortality并發(fā)癥分為兩類(lèi)：并發(fā)癥分為兩類(lèi)：These complications fall into 2 categories: 大血管病變:心血管疾病和腦血管疾病MACROVASCULAR: includes Cardiovascular and Cerebrovascular 微血管病變:視網(wǎng)膜病、腎病、神經(jīng)病MICROVASCULAR: includes

9、 Retinopathy, Nephropathy and Neuropathy糖尿病的并發(fā)癥使危險(xiǎn)性增加糖尿病的并發(fā)癥使危險(xiǎn)性增加Diabetes complications increase risk糖尿病病人患心臟病和中風(fēng)的危險(xiǎn)度比非糖尿病病人高糖尿病病人患心臟病和中風(fēng)的危險(xiǎn)度比非糖尿病病人高4 4倍倍Risk of heart disease or stroke can be 4X higher in diabetes patients vs. non-diabetic patients.2 2型型糖尿病、高血壓病人比非糖尿病、非高血壓病人的死亡率糖尿病、高血壓病人比非糖尿病、非高血壓

10、病人的死亡率高高7 7倍倍Type2 Diabetes, hypertensive patients have 7x increased mortality vs. non-diabetic, normotensive patients糖尿病性視網(wǎng)膜病變是經(jīng)濟(jì)發(fā)達(dá)國(guó)家成年人失明和視覺(jué)失能糖尿病性視網(wǎng)膜病變是經(jīng)濟(jì)發(fā)達(dá)國(guó)家成年人失明和視覺(jué)失能的首要原因的首要原因Diabetic retinopathy is the leading cause of blindness and visual disability in adults in economically developed societi

11、es.糖尿病性腎病占終末期腎衰的糖尿病性腎病占終末期腎衰的40%40%Diabetic nephropathy accounts for 40% of end-stage renal failure.糖尿病患者低位截肢的危險(xiǎn)度比非糖尿病病人高糖尿病患者低位截肢的危險(xiǎn)度比非糖尿病病人高40%40%Risk of lower extremity amputations is 40% higher in Diabetes patients. Vs.non-diabetic patients. Diabetes Care (1995) 21:1414-1431嚴(yán)格控制血糖的意義嚴(yán)格控制血糖的意義英國(guó)前

12、瞻性糖尿病研究（英國(guó)前瞻性糖尿病研究（UKPDS）表明：表明：UKPDS study showed the following; 嚴(yán)格控制血糖可降低視網(wǎng)膜病、腎病、神經(jīng)病的發(fā)生率嚴(yán)格控制血糖可降低視網(wǎng)膜病、腎病、神經(jīng)病的發(fā)生率Better hyperglycemia control reduces retinopathy, nephropathy and possible neuropathy 控制高血壓可降低中風(fēng)、心衰、失明、微血管并發(fā)癥和與糖尿病相控制高血壓可降低中風(fēng)、心衰、失明、微血管并發(fā)癥和與糖尿病相關(guān)的死亡的發(fā)生率關(guān)的死亡的發(fā)生率Controlling hypertension re

13、duces strokes, heart failure, visual loss, microvasular complications and Diabetes-related deaths.MESSAGE: 2型糖尿病治療管理應(yīng)以降低糖尿病并發(fā)癥發(fā)病率和嚴(yán)格控制血糖為目標(biāo)Insulin resistance management should be aimed at optimal control at blood glucose and hence reduction of co-morbidities主要內(nèi)容主要內(nèi)容Contents糖尿病流行病學(xué)糖尿病流行病學(xué)Epidemiology

14、 of diabetes mellitusCODIC方法學(xué)方法學(xué)CODIC methodologyCODIC項(xiàng)目糖尿病人口學(xué)特征項(xiàng)目糖尿病人口學(xué)特征Demographics of diabetic patients in CODIC2 2型糖尿病病人疾病負(fù)擔(dān)型糖尿病病人疾病負(fù)擔(dān)Disease burden of patients with type 2 diabetesCODIC方法學(xué)方法學(xué)CODIC methodology中國(guó)有中國(guó)有1111個(gè)省會(huì)城市參與了個(gè)省會(huì)城市參與了CODICCODIC項(xiàng)目：項(xiàng)目：CODIC covers 11 provincial capital Chinese c

15、ities: 北京、上海、廣州、成都、武漢、沈陽(yáng)、南京、濟(jì)南、西安、重慶、杭州Beijing, Shanghai, Guangzhou, Chengdu, Wuhan, Shenyang, Nanjing, Jinan, Xian, Chongqing, Hangzhou采訪了采訪了200200名內(nèi)分泌專(zhuān)家名內(nèi)分泌專(zhuān)家Interviews of 200 endocrinologists 40004000名糖尿病病人填寫(xiě)了調(diào)查問(wèn)卷名糖尿病病人填寫(xiě)了調(diào)查問(wèn)卷4000 Diabetes Patient Forms completed進(jìn)一步采訪了進(jìn)一步采訪了806806名有并發(fā)癥的名有并發(fā)癥的2 2型

16、糖尿病病人和型糖尿病病人和300300名無(wú)并發(fā)名無(wú)并發(fā)癥的糖尿病病人癥的糖尿病病人Further 806 Type2 diabetes patients with complications and 300 diabetic patients without complications interviewed2 2型糖尿病患者抽樣調(diào)查問(wèn)卷型糖尿病患者抽樣調(diào)查問(wèn)卷Type2 Diabetes patient sample questionnaire所有的費(fèi)用的數(shù)據(jù)來(lái)自對(duì)病人的訪問(wèn)所有的費(fèi)用的數(shù)據(jù)來(lái)自對(duì)病人的訪問(wèn)All Cost data derived from Patient intervie

17、ws請(qǐng)問(wèn)您是否患有請(qǐng)問(wèn)您是否患有2 2型糖尿病的并發(fā)癥型糖尿病的并發(fā)癥? ? *Do you suffer from diabetic complications due to T2DM ?*您患有下列哪些并發(fā)癥和或在過(guò)去的一年中接受過(guò)哪些治療？您患有下列哪些并發(fā)癥和或在過(guò)去的一年中接受過(guò)哪些治療？Which of these complications or procedures you are currently suffering from/have you undergone in the last year ? (complications as listed in next sli

18、de)在過(guò)去的一年中您由于在過(guò)去的一年中您由于2 2型糖尿病及其并發(fā)癥住過(guò)幾次醫(yī)院？型糖尿病及其并發(fā)癥住過(guò)幾次醫(yī)院？History of any hospitalisation due to T2DM or its complications during the last year ?在過(guò)去的一年中您由于在過(guò)去的一年中您由于2 2型糖尿病及其并發(fā)癥您看過(guò)幾次門(mén)診？型糖尿病及其并發(fā)癥您看過(guò)幾次門(mén)診？Number of medical consultations due to T2DM or its complications in the last year ?* only patients

19、with complications DUE TO T2DM are included in the study并發(fā)癥并發(fā)癥 - 調(diào)查病人的樣本量調(diào)查病人的樣本量Complications Patient Survey Sample SizeDM Complication selection based on ISIS PhV Therapy Monitor prevalence rate主要內(nèi)容主要內(nèi)容Contents糖尿病流行病學(xué)糖尿病流行病學(xué)Epidemiology of diabetes mellitusCODIC方法學(xué)方法學(xué)CODIC methodologyCODIC項(xiàng)目糖尿病人口學(xué)

20、特征項(xiàng)目糖尿病人口學(xué)特征Demographics of diabetic patients in CODIC2 2型糖尿病病人疾病負(fù)擔(dān)型糖尿病病人疾病負(fù)擔(dān)Disease burden of patients with type 2 diabetes2型糖尿病病人的人口統(tǒng)計(jì)學(xué)特征型糖尿病病人的人口統(tǒng)計(jì)學(xué)特征Type2 Diabetes patient demographics病人的平均年齡為58歲Patient Mean age is 58 years old.糖尿病平均病程約為6年Mean average duration of diabetes is about 6 years.2型糖尿病的

21、平均體重指數(shù)（BMI）為24kg/m2Mean average BMI of T2DM patients is 24 kg/m2WHO提出亞洲人的體重指數(shù)正常范圍為提出亞洲人的體重指數(shù)正常范圍為18.5-23 kg/m2WHO range for acceptable, normal, or optimum body-mass index (BMI) for Asian populations should be narrowed to 185-23 kg/m2, Message : 2型糖尿病人群有肥胖傾向Type2 Diabetes population has a propensity

22、for obesity.Lancet (2002) Vol 360血糖控制血糖控制Glycaemic control32%32%的病人血糖控制差的病人血糖控制差- -HbAIc7.5%HbAIc7.5%32% of patients have poor glycemic control (defined as HbAIc 7.5)只有只有3 37%7%口服降糖藥治療病人和口服降糖藥治療病人和47%47%胰島素治療的病人得到很好的血糖控胰島素治療的病人得到很好的血糖控制制Only 37% of patients on OHA and 47% on insulin had “good” glyce

23、mic control采用飲食和運(yùn)動(dòng)治療的病人平均采用飲食和運(yùn)動(dòng)治療的病人平均HbAIcHbAIc為為7.23%, 7.23%, 口服降糖藥治療的病人口服降糖藥治療的病人為為7.43% 7.43% ，胰島素治療的病人為胰島素治療的病人為6 6.25%.25%Patients treated with diet and exercise had a mean HbAIc of 7.23%, compared to patients on OHA with 7.43% and patients on insulin with 6.25%Message: 大多數(shù)病例表現(xiàn)出漸進(jìn)性大多數(shù)病例表現(xiàn)出漸進(jìn)性

24、細(xì)胞功能衰退、口服降糖藥治療失敗而不能細(xì)胞功能衰退、口服降糖藥治療失敗而不能維持血糖控制維持血糖控制Most likely reflects the progressive deterioration of beta cell function and the failure of current OHA therapies to provide sustained glycaemic controlISIS Diabetic Therapy Monitor PhVI 2002American Diabetic Association guidelines大城市大城市2 2型糖尿病病人的大血管

25、并發(fā)癥的患病率型糖尿病病人的大血管并發(fā)癥的患病率Prevalence of T2DM complications (macro-vascular) in urban cities并發(fā)癥并發(fā)癥（Complications）患病率（每千例有并發(fā)癥糖尿病患者中的患病率（每千例有并發(fā)癥糖尿病患者中的例數(shù)）例數(shù)）Prevalence (No. in 1000 complicated diabetic patients)TIA148心絞痛（Angina）109卒中（Stroke）77CHF24AMI23PTCA5CABG2ISIS Diabetic Therapy Monitor PhVI 2002大城市

26、大城市2 2型糖尿病病人的微血管并發(fā)癥的患病率型糖尿病病人的微血管并發(fā)癥的患病率Prevalence of T2DM complications (micro-vascular) in urban cities并發(fā)癥(Complications)患病率（每千例有并發(fā)癥糖尿病患患病率（每千例有并發(fā)癥糖尿病患者中的例數(shù)）者中的例數(shù)）Prevalence (No. in 1000 complicated diabetic patients)外周神經(jīng)病變（Peripheral Neuropathy)212光凝治療(Photocoagulation)202腎衰(Renal Failure)70足潰瘍(F

27、oot Ulcer)30失明(Blindness)15透析(Dialysis)4截肢(Amputation)3ISIS Diabetic Therapy Monitor PhVI 2002大城市大城市2 2型糖尿病病人的微血管并發(fā)癥的患病率型糖尿病病人的微血管并發(fā)癥的患病率Prevalence of T2DM complications (micro-vascular) in urban cities0.5%5.0%2.5%32.9%0.6%9.5%0.0%5.0%10.0% 15.0% 20.0% 25.0% 30.0% 35.0%截肢截肢(Amputation)足潰瘍足潰瘍(Foot Ul

28、cer)失明失明(Blindness)光凝固術(shù)光凝固術(shù)(Photocoagulation)透析透析(Dialysis)腎衰腎衰(Renal Failure)大城市大城市2 2型糖尿病病人的大血管并發(fā)癥的患病率型糖尿病病人的大血管并發(fā)癥的患病率Prevalence of T2DM complications (macro-vascular) in urban cities0.4%0.8%4.1%4.0%18.6%11.1%10.0%0.0%5.0%10.0%15.0%20.0%CABGPTCACHFAMI心絞痛心絞痛Angina卒中卒中StrokeTIA53.32%53.32%的糖尿病病人至少患

29、有一種并發(fā)癥的糖尿病病人至少患有一種并發(fā)癥53.32% of TII DM patients have at least one complication. 微血管并發(fā)癥： 22.33%22.33% of TII DM patients have DM micro complications. 大血管并發(fā)癥：13.30%13.30% of TII DM patients have DM macro complications. 兩者兼有：17.69%17.69% of TII DM patients have BOTH complications2型型糖尿病并發(fā)癥糖尿病并發(fā)癥TII DM co

30、mplicationsSource: ISIS Diabetic Therapy Monitor PhVI 20022 2型糖尿病并發(fā)癥的危險(xiǎn)性型糖尿病并發(fā)癥的危險(xiǎn)性Risk of Type2 Diabetes complicationsISIS Diabetes Therapy Monitor PhVI無(wú)并發(fā)癥無(wú)并發(fā)癥Non-complicated(46.7%)CABG (0.2%)PTCA (0.5%)CHF (2.4%)Angina (10.9%)MI (2.3%)Stroke (7.7%)TIA (14.8%)大血管并發(fā)癥大血管并發(fā)癥Macro-vascular(13.3%)Foot

31、Ulcer (3.0%)Amputation (0.3%)Clinical Blindness (1.5%)Photocoagulation (20.2%)Dialysis (0.4%)CRF (7.0%)微血管并發(fā)癥微血管并發(fā)癥Micro-vascular(22.3%)兩者兼有兩者兼有Both(17.7%)有并發(fā)癥有并發(fā)癥Complicated(53.3%)所有糖尿病人群所有糖尿病人群Total Diabetic Population100%Peripheral Neuropathy(21.2)糖尿病并發(fā)癥發(fā)病率（糖尿病并發(fā)癥發(fā)病率（% %） Diabetic complications %

32、ISIS Diabetic Therapy Monitor PhVI 20020%5%10%15%20%25%神經(jīng)病變神經(jīng)病變NeuropathyNeuropathy光凝固術(shù)光凝固術(shù)PhotocoagulationPhotocoagulation心絞痛心絞痛AnginaAngina腦血管病腦血管病Cerebrovascular diseaseCerebrovascular disease卒中卒中StrokeStroke短暫腦缺血發(fā)作短暫腦缺血發(fā)作TIATIA慢性腎衰慢性腎衰Chronic renal failureChronic renal failure足潰瘍足潰瘍Foot ulcerFoo

33、t ulcer慢性心衰慢性心衰CHFCHF心肌梗死心肌梗死Myocardial infarctionMyocardial infarction臨床失明臨床失明Clinical blindnessClinical blindness其他心血管病其他心血管病Other cardiovascularOther cardiovascular經(jīng)皮冠脈成形術(shù)經(jīng)皮冠脈成形術(shù)PTCAPTCA透析透析DialysisDialysis截肢截肢AmputationAmputation冠脈旁路移植術(shù)冠脈旁路移植術(shù)CABGCABG累積百分率累積百分率(Cumulative % of patients)2型糖尿病型糖尿病

34、(Type 2)2型型糖尿病并發(fā)癥糖尿病并發(fā)癥- -平均住院天數(shù)平均住院天數(shù)TII DM complications - Ave. Length of Hospital Stay (ALOS)加權(quán)住院時(shí)間（加權(quán)住院時(shí)間（Weighted ALOS）透析透析(Dialysis)40.5 足潰瘍足潰瘍(Foot Ulcer)36.2 冠狀動(dòng)脈旁路移植術(shù)冠狀動(dòng)脈旁路移植術(shù)(CABG)33.0 卒中卒中(Stroke)32.6 失明失明(Blindness)32.6截肢截肢(Amputation)31.2 腎衰腎衰(Renal failure)28.5 經(jīng)皮冠狀動(dòng)脈成形術(shù)經(jīng)皮冠狀動(dòng)脈成形術(shù)(PTCA)

35、23.5 短暫腦缺血發(fā)作短暫腦缺血發(fā)作(TIA)22.5急性心肌梗死急性心肌梗死(AMI)21.8慢性心衰慢性心衰(CHF)21.5 外周神經(jīng)病變（外周神經(jīng)病變（Peripheral Neuropathy)20.7心絞痛心絞痛(Angina)18.4 光凝固術(shù)光凝固術(shù)(Photocoagulation)16.3 Source: Result of ISIS Diabetic Patient Survey2型型糖尿病并發(fā)癥糖尿病并發(fā)癥- -平均住院天數(shù)平均住院天數(shù)TII DM complications - Ave. Length of Hospital Stay (ALOS)Source: R

36、esult of ISIS Diabetic Patient Survey010102020303040405050AMICHF心絞痛心絞痛AnginaCABGPTCA卒中卒中StrokeTIA足潰瘍足潰瘍Foot Ulcer截肢截肢Amputation失明失明Blindness光凝固術(shù)光凝固術(shù)Photocoagulation腎衰腎衰Renal failure透析透析Dialysis藥物治療藥物治療Drug Treatments98%以上的病人用口服降糖藥單獨(dú)治療，或者采用胰島素以上的病人用口服降糖藥單獨(dú)治療，或者采用胰島素+口口服降糖藥聯(lián)合治療或者是胰島素單獨(dú)治療服降糖藥聯(lián)合治療或者是胰島素

37、單獨(dú)治療*Over 98% of patients are managed with either OHA alone, insulin + OHA or insulin monotherapy* 口服降糖藥：64%64% of patients on OHA 口服降糖藥+胰島素：17%17% of patients on OHA & Insulin 胰島素：18%18% of patients on Insulin *Patients interview from ISIS Diabetic Therapy Monitor PhV藥物治療藥物治療Drug TreatmentsSour

38、ce: ISIS DM Therapy Monitor PhVPatient Interviews18%17%2%64%單用口服降糖藥單用口服降糖藥(OHA alone)單用胰島素單用胰島素(Insulin alone)口服降糖藥口服降糖藥+胰島素胰島素(Both OHA and Insulin)飲食控制飲食控制+運(yùn)動(dòng)運(yùn)動(dòng)(On diet or sports)主要內(nèi)容主要內(nèi)容Contents糖尿病流行病學(xué)糖尿病流行病學(xué)Epidemiology of diabetes mellitusCODE2導(dǎo)論導(dǎo)論Introduction of CODE2CODIC方法學(xué)方法學(xué)CODIC methodolo

39、gyCODIC項(xiàng)目糖尿病人口學(xué)特征項(xiàng)目糖尿病人口學(xué)特征Demographics of diabetic patients in CODIC2 2型糖尿病病人疾病負(fù)擔(dān)型糖尿病病人疾病負(fù)擔(dān)Disease burden of patients with type 2 diabetes中國(guó)大城市中國(guó)大城市II 型糖尿病直接醫(yī)療總成本型糖尿病直接醫(yī)療總成本Total Direct Medical Cost of treating Type2 Diabetes in urban China中國(guó)城市治療2型糖尿病及其并發(fā)癥的直接醫(yī)療總成本為189.42億RMB* (3.759億城市人口)Total Dire

40、ct Medical Cost of treating T2DM and its complication in urban China is billion RMB (US$2.29billion) (375.9m pop) (CODE2: (CODE2: 歐洲治療歐洲治療10001000萬(wàn)名以上萬(wàn)名以上2 2型糖尿病病人的直接醫(yī)療成本為型糖尿病病人的直接醫(yī)療成本為290290億億歐元?dú)W元) )(CODE2: Direct medical cost for 10million patients with Type II DM is 29 billion Euros( US$29.9billi

41、on).該費(fèi)用占中國(guó)醫(yī)療衛(wèi)生總費(fèi)用的3.98%（4764億RMB ）This accounts for 3.98% of total China healthcare expenditure (476.4 billion RMB).(CODE2: 5%(CODE2: 5%醫(yī)療衛(wèi)生總費(fèi)用醫(yī)療衛(wèi)生總費(fèi)用) )(CODE2: 5% of total healthcare expenditure).National Bureau of Statistics in China 2001The Yearbook of Chinas cities 2000Diabetologica (2002)45:S1-

42、S4該費(fèi)用計(jì)算包括：該費(fèi)用計(jì)算包括：This cost calculation includes：僅包括中國(guó)大城市人口（僅包括中國(guó)大城市人口（3.7593.759億人）億人）Only Chinas urban population is included ( 375.9 million)糖尿病患病率糖尿病患病率4.8%4.8%，其中，其中95%95%為為2 2型糖尿病型糖尿病Using diabetes prevalence rate of 4.8% of which 95% of all Diabetes are Type 2 Diabetes只有只有30%30%病人得到診斷，得到診斷的病人

43、中病人得到診斷，得到診斷的病人中40%40%接受接受治療（診斷并治療的病人占治療（診斷并治療的病人占12%12%）Only 30% of patients are diagnosed of which 40% of patients get treated ( Diagnosed and treated is 12% of total)46.7%46.7%的的2 2型糖尿病患者無(wú)并發(fā)癥型糖尿病患者無(wú)并發(fā)癥46.7%of T2DM patients do not have complications53.3%53.3%的的2 2型糖尿病患者有并發(fā)癥型糖尿病患者有并發(fā)癥53.3% of T2DM

44、patients have complicationsNational Bureau of Statistics in China 2001The Yearbook of Chinas cities 2000China Pharmaceutical Report, Vol 7, No.4ISIS Diabetic Therapy Monitor, Ph5 & 6中國(guó)大城市中國(guó)大城市2型型糖尿病直接醫(yī)療總成本糖尿病直接醫(yī)療總成本Total Direct Medical Cost of treating Type2 Diabetes in urban China10億人民幣Billion

45、RMB476.418.94050100150200250300350400450500中國(guó)的年醫(yī)療開(kāi)支中國(guó)的年醫(yī)療開(kāi)支Annual healthcareExpenditure in China中國(guó)大城市治療中國(guó)大城市治療2型糖尿病型糖尿病的每年直接醫(yī)療成本的每年直接醫(yī)療成本Annual direct medical cost of treating T2DM in Urban China3.98%2 型糖尿病占總醫(yī)療衛(wèi)生費(fèi)用的比較型糖尿病占總醫(yī)療衛(wèi)生費(fèi)用的比較: :中國(guó)中國(guó)歐洲歐洲Europe Comparison: T2 Diabetes as a % of total healthcare

46、 expenditure國(guó)家國(guó)家(Countries)2型型糖尿病占總醫(yī)療衛(wèi)生費(fèi)用百分比(T2DM as % of total healthcare expenditure)意大利(Italy)6.6%德國(guó)(Germany)6.5%中國(guó)(China)3.98%法國(guó)(France)3.4%英國(guó)(UK)2.5%荷蘭(Netherlands)1.6%中國(guó)大城市治療中國(guó)大城市治療2 2型糖尿病及其并發(fā)癥的總成本型糖尿病及其并發(fā)癥的總成本Total cost of treating T2 Diabetes and its complications in urban China成本(Cost)人民幣10

47、億RMB(Billion)直接醫(yī)療成本Direct Medical Cost18.94直接非醫(yī)療成本Direct Non-Medical Cost2.32間接成本Indirect Cost2.39總成本Total Cost23.65(US$2.86)中國(guó)大城市中國(guó)大城市2型糖尿病直接醫(yī)療總成本型糖尿病直接醫(yī)療總成本Direct medical cost of treating Type2 Diabetes in urban China治療無(wú)并發(fā)癥治療無(wú)并發(fā)癥2型糖尿病的直接醫(yī)療成本型糖尿病的直接醫(yī)療成本35.78億元人民幣億元人民幣Direct medical cost of treating

48、 Type2 Diabetes without complications is 3.578 billion RMB.治療有并發(fā)癥治療有并發(fā)癥2型糖尿病的直接醫(yī)療成本型糖尿病的直接醫(yī)療成本153.64億元人民幣億元人民幣Direct medical cost of treating Type2 Diabetes with complications is RMB 15.364 billion. 該費(fèi)用占中國(guó)大城市治療該費(fèi)用占中國(guó)大城市治療2型糖尿病直接醫(yī)療成本的型糖尿病直接醫(yī)療成本的 81.1%This accounts for 81.1% of direct medical cost of

49、treating T2DM in urban China.National Bureau of Statistics in China 2001The Yearbook of Chinas cities 2000 Epidemiology series for 21st Century (2000)4th version, Peoples Healthcare Publishing houseISIS Diabetic Therapy Monitor, Ph5 & 6中國(guó)治療糖尿病病人的直接醫(yī)療成本中國(guó)治療糖尿病病人的直接醫(yī)療成本Direct medical cost of treat

50、ing Diabetic patients in China10億元人民幣Billion RMB18.9%81.1%0.00%50.00%100.00%直接醫(yī)療成本直接醫(yī)療成本Direct Medical Cost有并發(fā)癥病人的直接醫(yī)療成本有并發(fā)癥病人的直接醫(yī)療成本(Direct Medical Cost for patients with complications無(wú)并發(fā)癥病人的直接醫(yī)療成本無(wú)并發(fā)癥病人的直接醫(yī)療成本(Direct Medical Cost for patients without complications每例病人的年均直接醫(yī)療成本每例病人的年均直接醫(yī)療成本Average

51、Annual Direct Medical Cost Per patient每例病人的年均直接醫(yī)療成本，無(wú)并發(fā)癥者為每例病人的年均直接醫(yī)療成本，無(wú)并發(fā)癥者為3726.36元，有元，有并發(fā)癥者為并發(fā)癥者為14009.00元，治療并發(fā)癥比單純治療糖尿病的費(fèi)用元，治療并發(fā)癥比單純治療糖尿病的費(fèi)用高高3.8倍倍Average annual direct medical cost per patient was 3726.36 RMB without complications compared to 14009.00 RMB for patients with complications. It co

52、st 3.8 times more to treat DM patients with complications.(CODE2:有糖尿病并發(fā)癥使治療費(fèi)用升高有糖尿病并發(fā)癥使治療費(fèi)用升高3.5倍倍)(CODE2: Presence of diabetic related complications increase the costs by over 3.5 times.年人均成本（年人均成本（3726.36元）占上海年人均可支配收入的元）占上海年人均可支配收入的32%，占西安年人均可支配，占西安年人均可支配收入的收入的73%This cost (3726.36 RMB) could acco

53、unt for 32% of per capita disposable income in Shanghai and 73% of that in Xian. National Bureau of Statistics in China 2001,The Yearbook of Chinas cities 2000 Epidemiology series for 21st Century (2000) 4th version, Peoples Healthcare Publishing houseNational Hospital Cost Yellow Book China 1997Chi

54、na Pharmaceutical Report, Vol 7, No.4ISIS Diabetic Therapy Monitor, Ph5 & 6病人年均直接醫(yī)療成本病人年均直接醫(yī)療成本Average Annual Direct Medical Cost Per Patient72.7%5124.24西安(Xian)69.6%5357.79沈陽(yáng)(Shenyang)67.5%5524.54武漢(Wuhan)63.2%5894.27成都(chengdu)59.4%6275.98重慶(Chongqing)57.4%6489.97濟(jì)南(Jinan)54.8%6800.23南京(Nanjin

55、g)40.2%9279.16杭州(Hangzhou)38.2%9761.57廣州(Guangzhou)36.0%10,349.69北京(Beijing)31.8%11718.01上海(Shanghai)無(wú)并發(fā)癥無(wú)并發(fā)癥2型糖尿病治療成本占人年均收入的比例型糖尿病治療成本占人年均收入的比例Treatment Cost of uncomplicated T2DM (3726.36 RMB) as % of APCI人年均收入人年均收入(RMB)Annual Per Capita Income城市城市(CITY)2001 Almanac of Chinas Economy2型型糖尿病并發(fā)癥的經(jīng)濟(jì)負(fù)擔(dān)

56、糖尿病并發(fā)癥的經(jīng)濟(jì)負(fù)擔(dān)Economic burden of T2DM complicationsDirect Med-ExpDirect non Med-ExpIndirect ExpFees%Fees%Fees%TotalAMI17521.4678.942376.3910.712298.8310.3622196.67CHF10577.8975.691546.9811.071850.5713.2413975.44Angina8726.1374.671726.9314.781233.0110.5511686.07CABG41070.2686.762138.104.524127.948.72473

57、36.29PTCA47225.4591.332460.424.762023.823.9151709.68Subtotal19798.5584.131890.598.031843.807.8323532.95Stroke18404.7477.512047.178.623291.9013.8623743.81TIA10021.6476.701572.9312.041471.3611.2613065.93Subtotal12818.0976.501757.6910.492180.6713.0116756.45Foot Ulcer11308.5273.781877.3112.252141.4013.9

58、715327.23Amputation14012.1472.921595.458.303609.2518.7819216.85Subtotal11152.2572.501827.3011.882401.8315.6215381.38Blindness34125.3292.461711.454.641070.392.9036907.16Photocoagulation25391.7585.051985.136.652477.748.3029854.62Subtotal24254.5086.521873.636.681904.386.7928032.51Renal failure20745.797

59、8.511580.555.984099.0215.5126425.36Dialysis137552.1294.423438.042.364696.433.22145686.59Subtotal48806.1788.502081.453.774260.127.7255147.74Peripheral Neuropathy5566.2772.781227.2216.05854.7211.187648.21Subtotal5566.2772.781227.2216.05854.7211.187648.21 2型型糖尿病并發(fā)癥的經(jīng)濟(jì)負(fù)擔(dān)糖尿病并發(fā)癥的經(jīng)濟(jì)負(fù)擔(dān) Economic burden of Ty

60、pe2 Diabetes complications2 型型糖糖尿尿病病并并發(fā)發(fā)癥癥 T2DM Complication 無(wú)無(wú)并并發(fā)發(fā)癥癥患患者者年年人人均均支支出出 Cost per T2DM patient with no complications 有有并并發(fā)發(fā)癥癥患患者者年年人人均均支支出出 Mean Average cost of Comlication 增增加加百百分分率率 % Increase 腎病科（Nephrology） 3726 48806 1310 眼科(Ophthalmic) 3726 24255 651 心血管系統(tǒng)(CVS) 3726 19799 531 神經(jīng)系統(tǒng)(CNS) 3726 12818 344 骨科(Orth