Hospitalisation rates, length and cost of hospitalisation of diabetic and non-diabetic patients in a tertiary hospital in Johannesburg
Date
2013-01-25
Authors
Ncube-Zulu, Tryphine
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Abstract
Background: Diabetes consumes between 5% and 10% of most countries’ health budgets with the majority of the costs being for hospitalisation, making analysis of hospital costs an integral part in the estimation of the costs of managing diabetes and its complications. Analysing direct costs makes a greater impact as these are costs that the healthcare professional best understands and deals with on a daily basis. The number of diabetes patients is on the increase worldwide with type 2 being the most prevalent and South Africa is no exception. The number of type 2 diabetic patients is expected to grow by 9% per annum and by 2012 will comprise about 93% of the entire diabetic population in South Africa. Diabetes mellitus was the sixth leading cause of death in 2008 in South Africa.
Aim: The main aim of the study was to compare the costs and length of hospitalisation between diabetic and non-diabetic patients for a cross-section of patients discharged with cerebrovascular diseases, ophthalmic conditions, cardiovascular diseases, renal conditions, neurological diseases (of the peripheral nervous system) and peripheral vascular diseases.
Methods: A cross-sectional retrospective audit of medical records of all patients discharged from Chris Hani Baragwanath Academic Hospital with the above mentioned six specific conditions between 1st and 31St December 2009 was conducted. These patients were identified using Medicom®, the hospital’s software system, and then grouped by ICD-10 codes listed on the database. The medical records were then manually analysed to determine the diabetes status of the patients, obtain information on lab tests and medical procedures performed and drugs prescribed during the admission period for which the patient was discharged during the period of the 1st to 31st December 2009. The frequency of hospitalisation of these patients during 2009 was also investigated.
Results:
Diabetic patients comprised 38.08% (N= 407) of the study sample. Average total hospitalisation costs per patient were significantly higher for diabetic cohorts; R27 216-06 ± R19 476-65 compared to R18 185-05 ± R16 725-90 for the non-diabetic patients, p<0.00001. The average length of stay for diabetic patients was longer; 13.04 ± 9.29 days vs. 8.86 ± 8.33 days (p<0.00001) for non-diabetic patients. Average admission rate per patient per year in -
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2009 was higher in diabetic patients 1.8 ± 0.8 times vs. 1.5 ± 0.6 times in non-diabetic patients, (p<0.00004).
Conclusion:
This study showed that patients with diabetes had higher costs and longer in-patient stays than non-diabetic patients for the admission episode for which they were discharged between 1st and 31st December 2009. Diabetic patients’ average total hospitalisation costs were 44% more than that of non-diabetic patients. Diabetes patients had a significantly higher average frequency of hospitalisation per patient for the year 2009. Cardiovascular disease was the most prevalent in both groups. Results from this study should be used to advocate for improved diabetes prevention awareness, improved patient understanding of the reasons for strict diabetes control measures and keen attendance in out-patient clinics to avoid unnecessary hospitalisation which leads to increased costs.