Time to Diabetes Related Complications for Newly Diagnosed Diabetes Patients in Singapore

VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 8 0 7 – A 9 1 8

(OR =  1.88, P< 0.0001) and HbA1c not at target (OR =  1.09, P< 0.014) were significant risk factors for ischaemic heart disease. Risk factors for cerebrovascular disease were similar except for uncontrolled HbA1c, and higher odds with hypertension (OR =  3.64, P < 0.0001) and dyslipidaemia (OR = 2.45, P < 0.0001). BMI was tested but no statistically significant association was found.  Conclusions: Our analysis showed that the factors associated with ischaemic heart disease in Malaysian diabetes patients were age, male sex, diabetes duration, uncontrolled HbA1c and the presence of hypertension and dyslipidaemia as comorbidities. These are generally consistent with past studies in the general population with the addition of uncontrolled HbA1c.as a risk factor. The same factors were associated with cerebrovascular disease except for uncontrolled HbA1c and a higher odds with hypertension and dyslipidaemia. PDB12 Metformin Treatment and Homocysteine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Li S, Zhang Q, Li L, Li Q, Ren K, Yu C, Kwong J, Sun X, Li J West China Hospital of Sichuan University, Chengdu, China

Objectives: We aimed to investigate the serum homocysteine (Hcy) changes in patients received metformin with or without supplementation of B-group vitamins.  Methods: A literature search was conducted systematically in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trails (RCTs) reporting serum Hcy level in metformintreated adults. Meta-analysis was applied to assess the association between metformin and the changes of Hcy concentration. The risk of bias of each included paper was assessed using Cochrane Handbook for Systematic Reviews of Interventions.  Results: Eleven papers had been included. In the overall analysis, metformin did not provide a statistically significant effect on the elevation of Hcy when compared with the control treatment (Mean Difference (MD), 0.02 μ mol/L; 95% CI, -0.41~0.44 μ mol/L, P= 0.94). In the subgroup analysis, administration of metformin was associated with an increased level of Hcy (MD, 1.74 μ mol/L; 95% CI, 1.21~2.27 μ mol/L, P< 0.00001) if exogenous supplementation of folic acid and B-group vitamins was absent, but a decreased serum level of Hcy (MD, -0.74 μ mol/L; 95% CI, -1.19~-0.30 μ mol/L, P= 0.001) when present.  Conclusions: Metformin administration could increase the concentration of Hcy without exogenous supplementation of B-groups vitamins or folic acid. Vitamin B12 or folic acid supplementation may be necessary in patients receiving metformin treatment. PDB13 Time to Diabetes Related Complications for Newly Diagnosed Diabetes Patients in Singapore Saxena N, Kannapiran P, Ang YG National Healthcare Group, Singapore, Singapore, Singapore

Objectives: This study aims to determine the cumulative incidence of diabetes related complications following diabetes onset and to determine the independent effect of age at onset of diabetes on the risk of developing diabetes related complications.  Methods: All patients with diabetes diagnosed in 2007 or later were included from a multi-regional health systems database. Diabetes complications were categorized into: Renal complications Cardiovascular disease (CVD) Eye complications Stroke Skin/Peripheral Vascular Disease/Neuropathy Complications were grouped into the above categories based on the Chronic Disease Management Database (CDMD) dictionary classifications. Patients were followed up to the development of the complication, death or were deemed alive as on 31/12/2014 (end of follow up)  Results: After adjusting for mean HbA1c, demographics and comorbidities, patients aged ≥  65 years had hazard ratios of 1.92, 1.47, 1.44, 3.36 and 3.53 for developing renal, eye, skin/Peripheral vascular disease/neuropathy, CVD and stroke respectively compared to patients aged < 40 years. The 1, 5 and 8 year disease free survival for all five complications were lowest for the ≥  65 years category patients compared to patients < 40 years and 40-64 years.  Conclusions: Cumulative incidence of diabetes related complications was significantly higher for patients with a late age at onset. Later age at onset of diabetes was significantly associated with diabetes related complications independent of HbA1c, ethnicity, gender and co-morbidities. Mean time (conditional) to a diabetes complication was not too high for the < 40 years group compared to the ≥  65 years group. Longer follow up is needed to determine the true median time to event for each complication.

Diabetes/Endocrine Disorders – Cost Studies PDB14 Gestational Diabetes Screening for Chinese Women: A CostEffectiveness Analysis Ming WK SUN YAT-SEN UNIVERSITY, Guangzhou, China

Objectives: The prevalence of gestational diabetes (GDM) is growing in China, and it is associated with a boosted risk of complications for the mother and neonate, such as pre-eclampsia, intrauterine death, stillbirth, post-partum type 2 diabetes, and macrosomia. GDM is also related with birth trauma, hypoglycemia, hyperbilirubinemia, respiratory distress, long-term obesity and childhood diabetes. Early determination and treatment of GDM can significantly diminish the incidence of these complications. The diagnostic criteria for GDM, however, remain questionable whether it is cost-effective or not. The objective of this study is to investigate the cost effectiveness of new American Diabetes Association (ADA) guideline on GDM screening in China.  Methods: A decision analytic model was built to compare new GDM criteria (ADA 2011) and old criteria in China. All probabilities, costs, and benefits were derived from the literature. Base case, sensitivity analyses, and a Monte Carlo simulation were performed.  Results: Screening with the 75g-OGTT was more expensive and effective. In a 1-way sensitivity analysis, the ADA 2011 diag-

A897

nostic approach remained cost-effective even triple of patients were diagnosed and treated for gestational diabetes mellitus. ADA 2011 diagnostic approach, however, was no longer cost-effective when long-term maternal and neonatal outcomes were not considered.  Conclusions: Screening at 24-28 weeks’ gestational age under the ADA 2011 guidelines with the 2h OGTT is expensive but cost effective in improving long-term maternal and neonatal outcomes. PDB15 Estimation of National Economic Burden of Hypoglycaemia Among Type 2 Diabetes Mellitus Patients in Malaysia Aljunid SM1, Nur A2, Ismail A2, Aung YN3 1Kuwait University, Kuwait City, Kuwait, 2Universiti Kebangsaan Malaysia, Cheras, Malaysia, 3UCSI University, Cheras, Malaysia

Objectives: Hypoglycaemia is a common emergency department presentation, and is inevitable in 90% of diabetics with insulin therapy. In Malaysia, a quarter of confirmed diabetes is on insulin therapy. The objective of this study is to identify the cost of hypoglycaemia among patient Type II Diabetes Mellitus and to estimate the national burden of this condition.  Methods: All patients aged between 20-79 years admitted to Universiti Kebangsaan Malaysia Medical Centre between January 2010 and September 2015 with primary diagnosis of hypoglycaemia in the MY-DRG® Casemix database were included in this study. Costing analysis was completed using step-down approach. Data related to hospital cost were collected using hospitalcosting template, for three levels of cost centres:overhead, intermediate and Final cost centres. Information on the pattern of admissions and outpatients visits to estimate the national burden were obtained from an earlier published Hypoglycaemia Assessment Tool (HAT) global study for Malaysian cohort.  Results: Within the study period, 244 diabetics were admitted to UKMMC primarily for hypoglycaemia. 88% of the cases were over 50 years old. Female had higher chance of being admitted for hypoglycaemia (52%). The median length of stay in hospital was 5 days (ranging from 2 to 26 days). The median cost for a hypoglycaemic case was RM 5,500 for severity level I, RM 6,875 for severity level II and RM 8,250 for severity level III. The total cost of care for hypoglycaemia among adult diabetes in Malaysia is estimated to be RM 117.9 million which is 0.53% of Ministry of Health budget. The national economic burden estimates based on the best-case scenario and the worst-case scenario ranges from RM 109.8 million to RM 138.3 million.  Conclusions: Regardless of seemingly a simple condition, hypoglycaemia can result in a substantial economic burden. Proper diabetic management and health education is neeed in diabetic management. PDB16 Factors Associated with Glycemic Control and Diabetes-Related Costs in Patients with Diabetes in the United Arab Emirates: Results From A Retrospective Large Claims Data Analysis CHOI YC, Lee YJ, Lee SH, Chang C, Song I, Suh D Chung-Ang University, Seoul, South Korea

Objectives: This study aimed to estimate the proportion of patients with diabetes who achieved target glycemic control, identify factors associated with poor glycemic control, estimate diabetes-related costs attributable, and examine characteristics associated with diabetes-related costs in the United Arab Emirates.  Methods: This retrospective cohort study used administrative claims data (January 2010 to June 2012) to determine glycemic control (hemoglobin A1c [HbA1c] < 7.0% in the 1-year follow-up period) and diabetes-related costs. Factors associated with glycemic control were investigated using multivariable logistic regression. Factors associated with diabetes-related costs were determined using a generalized linear model.  Results: During the 1-year follow-up period, 46.6% of the patients achieved HbA1c < 7%. Older age, female sex, better insurance coverage, non-use of insulin in the index diagnosis month, and non-use of antidiabetic medications during the follow-up period were significantly associated with improved glycemic control. The mean diabetes-related annual costs were $2,235 and $2,613 for patients with and without glycemic control, respectively, and the cost attributable to poor glycemic control was $168 ([CI], $160–177). The diabetes-related costs were lower with mean HbA1c levels < 7% (cost ratio, 0.91; CI, 0.88–0.99; p <  0.05). The costs were significantly higher in ≥ 65-year-olds than < 44-year-olds (cost ratio, 1.45; CI, 1.25–1.70; p <  0.001).  Conclusions: More than 50% of diabetic patients had poorly controlled HbA1c. Diabetes-related costs were higher with poor control, and the difference was significantly higher with older age. PDB17 Cost-Effectiveness of Biphasic Insulin Aspart 50 Versus Biphasic Human Insulin 50 in People with Type 2 Diabetes Mellitus in China Wang H1, Liu X2, Wan L1, Sun X1, Chen K3, Zhang Y4 People’s Hospital, Yancheng, China, 2Dongtai Peoples’ Hospital, Yancheng, China, 3Jiangsu Funing Peoples’ Hospital, Yancheng, China, 4Novo Nordisk(China) Pharmaceuticals Co., Ltd, Beijing, China 1Yancheng Tinghu

Objectives: To evaluate cost-effectiveness of biphasic insulin aspart 50 (BIAsp 50) versus biphasic human insulin 50(BHI 50) in people with type 2 diabetes mellitus (T2DM) in China.  Methods: The IMS Core Diabetes Model was used to project life expectancy, quality-adjusted life years (QALYs) and total direct medical costs over a 30-year time horizon. Baseline characteristics and treatment effects were based on a published 12-week head-to-head clinical trial for BIAsp 50 versus BHI 50 among people with T2DM in China. Insulin costs were calculated based on average bidding price and dose used in the trial. Diabetes management and complication unit costs were obtained from Chinese published data and adjusted to 2014. Costs and health outcomes were discounted at 3% annually. One-way sensitivity analyses were performed.  Results: In the base-case analysis, people with BIAsp 50 have more time alive and free of complications. BIAsp 50 was associated with longer life expectancy (12.246 versus 11.749 years), more QALYs (8.364versus 7.625QALYs), and higher total costs (CNY 196,519 versus 194,202), leading to an incremental cost-effectiveness ratio of CNY 3,140/QALY gained. Sensitivity analyses including discounting rate