Diabetes care cascade in Ukraine: An analysis of breakpoints and opportunities for improved diabetes outcomes
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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Diabetes care cascade in Ukraine : An analysis of breakpoints and opportunities for improved diabetes outcomes. / Stuart, Robyn Margaret; Khan, Olga; Abeysuriya, Romesh; Kryvchun, Tetyana; Lysak, Viktor; Bredikhina, Alla; Durdykulyieva, Nina; Mykhailets, Volodymyr; Kaidashova, Elvira; Doroshenko, Olena; Shubber, Zara; Wilson, David; Zhao, Feng; Fraser-Hurt, Nicole.
I: BMC Health Services Research, Bind 20, Nr. 1, 409, 2020.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Diabetes care cascade in Ukraine
T2 - An analysis of breakpoints and opportunities for improved diabetes outcomes
AU - Stuart, Robyn Margaret
AU - Khan, Olga
AU - Abeysuriya, Romesh
AU - Kryvchun, Tetyana
AU - Lysak, Viktor
AU - Bredikhina, Alla
AU - Durdykulyieva, Nina
AU - Mykhailets, Volodymyr
AU - Kaidashova, Elvira
AU - Doroshenko, Olena
AU - Shubber, Zara
AU - Wilson, David
AU - Zhao, Feng
AU - Fraser-Hurt, Nicole
PY - 2020
Y1 - 2020
N2 - Background: Diabetes is one of the leading causes of poor health and high care costs in Ukraine. To prevent diabetes complications and alleviate the financial burden of diabetes care on patients, the Ukrainian government reimburses diabetes medication and provides glucose monitoring, but there are significant gaps in the care continuum. We estimate the costs of providing diabetes care and the most cost-effective ways to address these gaps in the Poltava region of Ukraine. Methods: We gathered data on the unit costs of diabetes interventions in Poltava and estimated expenditure on diabetes care. We estimated the optimal combination of facility-based and outreach screening and investigated how additional funding could best be allocated to improve glucose control outcomes. Results: Of the ~ 40,000 adults in diabetes care, only ~ 25% achieved sustained glucose control. Monitoring costs were higher for those who did not: by 10% for patients receiving non-pharmacological treatment, by 61% for insulin patients, and twice as high for patients prescribed oral treatment. Initiatives to improve treatment adherence (e.g. medication copayment schemes, enhanced adherence counseling) would address barriers along the care continuum and we estimate such expenditures may be recouped by reductions in patient monitoring costs. Improvements in case detection are also needed, with only around two-thirds of estimated cases having been diagnosed. Outreach screening campaigns could play a significant role: depending on how well-targeted and scalable such campaigns are, we estimate that 10-46% of all screening could be conducted via outreach, at a cost per positive patient identified of US$7.12-9.63. Conclusions: Investments to improve case detection and treatment adherence are the most efficient interventions for improved diabetes control in Poltava. Quantitative tools provide essential decision support for targeting investment to close the gaps in care.
AB - Background: Diabetes is one of the leading causes of poor health and high care costs in Ukraine. To prevent diabetes complications and alleviate the financial burden of diabetes care on patients, the Ukrainian government reimburses diabetes medication and provides glucose monitoring, but there are significant gaps in the care continuum. We estimate the costs of providing diabetes care and the most cost-effective ways to address these gaps in the Poltava region of Ukraine. Methods: We gathered data on the unit costs of diabetes interventions in Poltava and estimated expenditure on diabetes care. We estimated the optimal combination of facility-based and outreach screening and investigated how additional funding could best be allocated to improve glucose control outcomes. Results: Of the ~ 40,000 adults in diabetes care, only ~ 25% achieved sustained glucose control. Monitoring costs were higher for those who did not: by 10% for patients receiving non-pharmacological treatment, by 61% for insulin patients, and twice as high for patients prescribed oral treatment. Initiatives to improve treatment adherence (e.g. medication copayment schemes, enhanced adherence counseling) would address barriers along the care continuum and we estimate such expenditures may be recouped by reductions in patient monitoring costs. Improvements in case detection are also needed, with only around two-thirds of estimated cases having been diagnosed. Outreach screening campaigns could play a significant role: depending on how well-targeted and scalable such campaigns are, we estimate that 10-46% of all screening could be conducted via outreach, at a cost per positive patient identified of US$7.12-9.63. Conclusions: Investments to improve case detection and treatment adherence are the most efficient interventions for improved diabetes control in Poltava. Quantitative tools provide essential decision support for targeting investment to close the gaps in care.
KW - Care cascades
KW - Diabetes
KW - Modeling
KW - Optimization
KW - Service delivery
UR - http://www.scopus.com/inward/record.url?scp=85084530592&partnerID=8YFLogxK
U2 - 10.1186/s12913-020-05261-y
DO - 10.1186/s12913-020-05261-y
M3 - Journal article
C2 - 32393341
AN - SCOPUS:85084530592
VL - 20
JO - BMC Health Services Research
JF - BMC Health Services Research
SN - 1472-6963
IS - 1
M1 - 409
ER -
ID: 242662910