关键词: 2型糖尿病, 三师共管, 卫生技术评估, 增量成本效果, 增量成本效益

Abstract: Objective To examine the short-term effect of “co-management of doctors of three kinds” on diabetes patients in Xiamen and make short-term cost-effectiveness and cost-benefit analysis. Methods A cross-sectional survey was performed among community residents with T2DM in Xiamen from July to August in 2016. Diabetes patients who had been in the “co-management of doctors of three kinds” for 1 year were enrolled in intervention group, and patients with chronic disease management during the same period were enrolled in control group. Questionnaires were designed to collect the information of the patients. The cost of intervention was measured. The effectiveness indexes included biochemical indicators, hierarchical medical indicators, knowledge of diabetes, diabetes self-management, and quality of life. The benefit was measured by the reduction of economic burden in “co-management of doctors of three kinds”. Results Eight hundred community residents were investigated in the study, and 798 valid questionnaires were collected(99.75%). Among them, there were 413 patients in intervention group and 385 in control group. After 1 years management, the control rates of hemoglobin A1c(HbA1c)levels and 2 h postprandial plasma glucose in intervention group 山 东 大 学 学 报 (医 学 版)57卷8期 -曾雁冰,等. 厦门市糖尿病“三师共管”模式的卫生经济学评价 \=-(74.8%, 79.9%)were significantly higher than those in control group(41.0%, 66.0%)(t=86.63, 19.14; all P<0.05). Besides, the rates of community first diagnosis and two-way referral,the knowledge of diabetes and the ability of self-management were all improved(t=12.59,82.42,12.54,10.40; all P<0.05). Per capita economic burden of disease in intervention group was 5 569 yuan per year, which was 1 412 yuan less than that in control group. One year after the intervention, the cost of intervention was 15.04 yuan per person per year for increasing the biochemical index such as HbA1c control rate by 1%. The cost of 1% increase of 2 hours postprandial blood glucose was 36.47 yuan per person per year. Hierarchical medical indicators such as two-way referral, community first visit rate, knowledge of diabetes and self-management compliance rate of 1% increase were 51.57,16.73,40.00 and 47.34 yuan per person per year, respectively. The incremental cost-benefit ratio was 2.78. Conclusion Compared with routine management, short-term intervention of “co-management of doctors of three kinds” can significantly improve T2DM patients glucose controlling, knowledge of diabetes, self-management, community first diagnosis and two-way referral. It can also significantly decrease the economic burden of disease. Thus the model shows better cost-effectiveness and cost-benefit for diabetes patients.

Key words: Type Ⅱ diabetes, Co-management of doctors of three kinds, Health technology assessment, Incremental cost effectiveness, Incremental cost-benefit