EFFECTIVENESS AND COST-BENEFIT-ANALYSIS OF INTENSIVE TREATMENT AND TEACHING PROGRAMS FOR TYPE-1 (INSULIN-DEPENDENT) DIABETES-MELLITUS IN MOSCOW - BLOOD-GLUCOSE VERSUS URINE GLUCOSE SELF-MONITORING

In a prospective controlled trial the effects of a 5-day in-patient treatment and teaching programme for Type 1 (insulin-dependent) diabetes mellitus on metabolic control and health care costs were studied in Moscow. Two different intervention programmes were compared, one based upon urine glucose self-monitoring (UGSM, n = 61) and one using blood glucose self-monitoring (BGSM, n = 60). Follow-up was 2 years. A control group (n = 60) continued the standard treatment of the Moscow diabetes centre and was followed-up for 1 year. Costs and benefits with respect to hospitalizations and lost productivity (according to average wage) were measured in November 1992 roubles (Rb.), with respect to imported drugs and test strips in 1992 German marks (DM). In the intervention groups there were significant decreases of HbA(1), values [UGSM: 12.5% before, 9.4% after 1 year, 9.2% after 2 years (p < 0.0001); BGSM: 12.6% before, 9.3% after 1 year, 9.2% after 2 years (p < 0.0001) compared to no change in the control group (12.2% before, 12.3% after 1 year)], and of the frequency of ketoacidosis. The frequency of severe hypoglycaemia was comparable between the UGSM (10 cases during 2 years), BGSM (10 cases during 2 years), and the control group (8 cases during 1 year). In the combined intervention groups, there were significant decreases of hospital days per patient per year (12.1 during the year before, 1.0 year one after, 3.6 year two after, p < 0.005), and of additional sick leave days (16.6 during the year before, 2.4 year one, 7.8 year two after, p < 0.01), whereas these parameters remained unchanged in the control group. The initial costs of the intervention were outweighed by this subsequent reduction in hospitalizations and lost productivity. Net savings totalled up to 14400 Rb./patient within 2 years. Patients of the intervention groups were told to discontinue drugs which were not indicated and/or ineffective (clofibrate, pentoxifylline, calcium dobesilate). This caused estimated average savings of DM 240 per patient per year. Costs of test strips for UGSM were DM 180 per patient per year; for BGSM they were estimated to lie between DM 370 and DM 550 per patient per year, depending on the frequency of measurements. In conclusion, the intervention led to an improvement of metabolic control and saved resources for health care by reducing hospitalizations and sick leave days. When UGSM is used, costs of test strips are approximately outweighed by discontinuing ineffective drugs.