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 -