
Evaluation of the Cost-Effectiveness of
Different Insulin Regimes during the Peri-
Operative Period in Type-2 Diabetics in India
1064-1068
Correspondence
Mushtaq Ahmad
Assistant Professor, Dept. of Pharmacology
Mahatma Gandhi Medical College & Hospital,
Sitapura, Jaipur-302022.
Phone: 9460983755;
E-mail: marumush@gmail.com
Background and Objectives: Diabetes accounts for at least 10% of the total expenditure in many countries. Diabetics who undergo surgery are prone to adverse outcomes that can prolong their hospital stay and increase their health care expenditure. This prompted the present study to compare the cost-effectiveness of different insulin regimes during the perioperative period in type 2 diabetics.
Study Design: This study was a multi-centric, prospective, single blind, randomised study. Two hundred eighty nine type 2 diabetes mellitus patients who underwent major elective surgeries were enrolled and randomly allocated to four groups A, B, C and D, receiving pre-mixed Regular/NPH(30:70), splitmixed Regular/NPH, split-mixed Glargine/Lispro and split-mixed Detemir/Aspart, respectively.
Materials and Methods: Each group received multiple injections from the preoperative to the postoperative period until the patients were switched back to the same treatment regime which they received preoperatively. The starting dose of the insulin was 0.5 units per/kg body weight, which was then adjusted to maintain the average blood glucose level between 120-180mg/dl during the peri-operative period. The cost-effectiveness was calculatedand the interventions were compared on the basis of the amount which was needed to treat the patient. The average one day cost for all the regimes was calculated and the total cost was divided by the percentage of the success of the regime by applying an incremental cost-effectiveness formula. The Chi-square test was employed for analysis of the complications and one way ANOVA was used for the rest of the data. A probability value of less than 0.05 (p<0.05) was considered to be statistically significant.
Results: There was a highly significant difference (p<0.001) in the mean costs of the regime A, B, C and D, respectively. The cost-effectiveness was done in a fashion of regime A vs. B and regime C vs. D. The incremental cost of the treatment for regime B was Rs. 7.21 and for regime D, it was Rs. 20.17 per added patient, with no peri-operative complications. However, the percentage of the incidence of the complications and the total cost was comparatively low with regime A.
Conclusions: This study found the pre-mixed NPH/regular (30:70) regime to be a cost-effective therapy among the regimes which were compared, while the split-mixed (NPH) regime posed a greater financial burden on the patient in terms of the complications which occurred and the total cost of the treatment.