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Articles by N. Shah
Total Records ( 2 ) for N. Shah
  S. Eaton , S. Brent , N. Shah and G. Masters

Aims To establish if a relationship exists between the prescribing costs of diabetes treatments and the achievement of Quality and Outcome Framework DM6 standards of glycaemic control.

Methods A retrospective cross-sectional study of all 92 primary care organizations in the north of England comparing net ingredient cost of diabetes treatments, corrected for diabetic population, with the percentage of patients achieving HbA1c <7.4% (Quality and Outcome Framework DM6 indicator).

Results The overall net ingredient cost for diabetes treatments varies from £225 to £382 per person per year. On regression analysis, expenditure on all diabetes treatments, on glitazones or on blood glucose test strips have no significant impact upon the percentage of people achieving an HbA1c <7.4%. There is an inverse relationship between spending on analogue insulins and target achievement (r=−0.08, P=0.001).

Conclusions At primary care organization level, there is no association between weighted expenditure on diabetes treatments and achievement of glycaemic control targets. Although there are limitations to what can be inferred from analyses of this type, these data support a judicious and carefully directed approach to the use of newer, more expensive treatments until clear evidence of added benefit is forthcoming.

  J. D. Goldhaber-Fiebert , H. Li , S. Ratanawijitrasin , S. Vidyasagar , X. Y. Wang , S. Aljunid , N. Shah , Z. Wang , S. Hirunrassamee , K. L. Bairy , J. Wang , S. Saperi , A. M. Nur and K. Eggleston
  Aims The prevalence of Type 2 diabetes mellitus (DM) has grown rapidly, but little is known about the drivers of inpatient spending in low- and middle-income countries. This study aims to compare the clinical presentation and expenditure on hospital admission for inpatients with a primary diagnosis of Type 2 DM in India, China, Thailand and Malaysia.
Methods We analysed data on adult, Type 2 DM patients admitted between 2005 and 2008 to five tertiary hospitals in the four countries, reporting expenditures relative to income per capita in 2007.
Results Hospital admission spending for diabetic inpatients with no complications ranged from 11 to 75% of per-capita income. Spending for patients with complications ranged from 6% to over 300% more than spending for patients without complications treated at the same hospital. Glycated haemoglobin was significantly higher for the uninsured patients, compared with insured patients, in India (8.6 vs. 8.1%), Hangzhou, China (9.0 vs. 8.1%), and Shandong, China (10.9 vs. 9.9%). When the hospital admission expenditures of the insured and uninsured patients were statistically different in India and China, the uninsured always spent less than the insured patients.
Conclusions With the rising prevalence of DM, households and health systems in these countries will face greater economic burdens. The returns to investment in preventing diabetic complications appear substantial. Countries with large out-of-pocket financing burdens such as India and China are associated with the widest gaps in resource use between insured and uninsured patients. This probably reflects both overuse by the insured and underuse by the uninsured.
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