Direct medical costs in the preceding, event and subsequent years of first severe hypoglycaemia requiring hospital transfer: A population-based cohort study

Aims To estimate healthcare services use and the direct medical costs accrued by patients with diabetes mellitus (DM) in the year of first severe hypoglycaemia (SH), the years before and after event year. Materials and Methods We analyzed a population‐based, retrospective cohort including all DM adults managed in primary care setting from the Hong Kong Hospital Authority between 2006‐2013. DM patients who had first recorded SH during the observation period were identified, and matched to control group of patients without SH based on the propensity score method. Direct medical costs in the years before, during and after the first SH were determined by summing up the costs of health services utilized within respective year. Results After matching, a total of 22,694 DM patients was identified in first recorded SH group (n=11,347) and non‐SH control group (n=11,347). Patients with first SH on average utilized 7.85 outpatient clinic visits, 1.89 emergency visits and 17.75 nights of hospitalization in the event year. Mean direct medical cost in the event year was US$11,751, more than twofold of that in the preceding year (US$4,846, p<0.001) and subsequent years (US$4,198‐4,700, p<0.001), and 4.5 times of that in two years before the event (US$2,481, p<0.001). Incremental costs of SH versus matched control in the event year and preceding year were US$10,873 (p<0.001) and US$3,974 (p<0.001), respectively. Conclusions SH is associated with excessive hospitalization admission rates and direct medical costs in the event year and, in particular, in the year before as compared to patients without SH

Bariatric surgery is expensive but improves co-morbidity: 5-year assessment of patients with obesity and type 2 diabetes

Background: Bariatric surgery can be effective in weight reduction and diabetes remission in some patients, but is expensive. The costs of bariatric surgery in patients with obesity and type 2 diabetes mellitus (T2DM) were explored here. Methods: Population‐based retrospectively gathered data on patients with obesity and T2DM from the Hong Kong Hospital Authority (2006–2017) were evaluated. Direct medical costs from baseline up to 60 months were calculated based on the frequency of healthcare service utilization and dispensing of diabetes medication. Charlson Co‐morbidity Index (CCI) scores and co‐morbidity rates were measured to compare changes in co‐morbidities between surgically treated and control groups over 5 years. One‐to‐five propensity score matching was applied. Results: Overall, 401 eligible surgical patients were matched with 1894 non‐surgical patients. Direct medical costs were much higher for surgical than non‐surgical patients in the index year (€36 752 and €5788 respectively; P &lt; 0·001) mainly owing to the bariatric procedure. The 5‐year cumulative costs incurred by surgical patients were also higher (€54 135 versus €28 603; P &lt; 0·001). Although patients who had bariatric surgery had more visits to outpatient and allied health professionals than those who did not across the 5‐year period, surgical patients had shorter length of stay in hospitals than non‐surgical patients in year 2‐5. Surgical patients had significantly better CCI scores than controls after the baseline measurement (mean 3·82 versus 4·38 at 5 years; P = 0·016). Costs of glucose‐lowering medications were similar between two groups, except that surgical patients had significantly lower costs of glucose‐lowering medications in year 2 (€973 versus €1395; P = 0.012). Conclusion: Bariatric surgery in obese patients with T2DM is expensive, but leads to an improved co‐morbidity profile, and reduced length of hospitalization

Utlilisation patterns of primary health care services in Hong Kong: does having a family doctor make any difference?

Primary care should be a gate-keeper for secondary health services to prevent illness, improve health, enable coping with illness, and satisfy needs. The family doctor model has been proposed by the government as a solution for the rising demand for quality primary health care services for the ageing population in Hong Kong. This study aimed to explore the utilisation rates and patterns of various primary health care services, and the process and outcomes of primary care consultations in Hong Kong, and whether having a family doctor makes any difference.&lt;p&gt;&lt;/p&gt; The objectives were to determine the rates and patterns of utilisation of different primary health care services, the process (including non-drug managements) and patient self-reported outcomes (enablement, change in health, and satisfaction) following primary care consultations, and any difference in the care for people with and without a regular family doctor

Patient morbidity and management patterns of community-based primary health care services in Hong Kong

Population ageing and changes in the socioeconomic structure affect the disease pattern. Chronic diseases and psychological illnesses are major health care burdens in the 21st century.1 Primary care doctors are taking care of an increasing load of patients with chronic illness.&lt;p&gt;&lt;/p&gt; This study aimed to explore the patterns of diseases and their management presenting to primary care doctors in Hong Kong, and whether different funding methods had an effect on these patterns

Population based study of noncardiac chest pain in southern Chinese: Prevalence, psychosocial factors and health care utilization

Aim: Population-based assessment of noncardiac chest pain (NCCP) is lacking. The aim of this study was to evaluate the prevalence, psychosocial factors and health seeking behaviour of NCCP in southern Chinese. Methods: A total of 2 209 ethnic Hong Kong Chinese households were recruited to participate in a telephone survey to study the epidemiology of NCCP using the Rose angina questionnaire, a validated gastroesophageal reflux disease (GERD) questionnaire and the hospital anxiety-depression scale. NCCP was defined as non-exertional chest pain according to the Rose angina questionnaire and had not been diagnosed as ischaemic heart diseases by a physician. Results: Chest pain over the past year was present in 454 subjects (20.6%, 95% CI 19-22), while NCCP was present in 307 subjects (13.9%, 95% CI 13-15). GERD was present in 51% of subjects with NCCP and 34% had consulted a physician for chest pain. Subjects with NCCP had a significantly higher anxiety (P<0.001) and depression score (P=0.007), and required more days off (P=0.021) than subjects with no chest pain. By multiple logistic regression analysis, female gender (OR 1.9, 95% CI 1.1-3.2), presence of GERD (OR 2.8, 95% CI 1.6-4.8), and social life being affected by NCCP (OR 6.9, 95% CI 3.3-15.9) were independent factors associated with health seeking behaviour in southern Chinese with NCCP. Conclusion: NCCP is a common problem in southern Chinese and associated with anxiety and depression. Female gender, GERD and social life affected by chest pain were associated with health care utilization in subjects with NCCP. Copyright © 2004 by The WJG Press