Evidence map›Paper›PMID 32393341›Full record

ArticleBMC health services research2020

Diabetes care cascade in Ukraine: an analysis of breakpoints and opportunities for improved diabetes outcomes.

Robyn Margaret Stuart, Olga Khan, Romesh Abeysuriya, Tetyana Kryvchun, Viktor Lysak, Alla Bredikhina, Nina Durdykulyieva, Volodymyr Mykhailets, Elvira Kaidashova, Olena Doroshenko and 4 more

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Article in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Robyn Margaret StuartDepartment of Mathematical Sciences, University of Copenhagen, Universitetsparken 5, København Ø, 2300, Copenhagen, Denmark. robyn@math.ku.dk.ORCID http://orcid.org/0000-0001-5482-9584
Olga KhanThe World Bank Group, Washington, DC, USA.
Romesh AbeysuriyaMonash University, Melbourne, Australia.
Tetyana KryvchunDepartment of Health, Poltava, Ukraine.
Viktor LysakDepartment of Health, Poltava, Ukraine.
Alla BredikhinaDepartment of Health, Poltava, Ukraine.
Nina DurdykulyievaDepartment of Health, Poltava, Ukraine.
Volodymyr MykhailetsDepartment of Health, Poltava, Ukraine.
Elvira KaidashovaDepartment of Health, Poltava, Ukraine.
Olena DoroshenkoThe World Bank Group, Washington, DC, USA.
Zara ShubberThe World Bank Group, Washington, DC, USA.
David WilsonThe World Bank Group, Washington, DC, USA.
Feng ZhaoThe World Bank Group, Washington, DC, USA.
Nicole Fraser-HurtThe World Bank Group, Washington, DC, USA.

Funding

Bill and Melinda Gates Foundation OPP1181918
6 · The paper itself

Abstract

backgroundDiabetes is one of the leading causes of poor health and high care costs in Ukraine. To prevent diabetes complications and alleviate the financial burden of diabetes care on patients, the Ukrainian government reimburses diabetes medication and provides glucose monitoring, but there are significant gaps in the care continuum. We estimate the costs of providing diabetes care and the most cost-effective ways to address these gaps in the Poltava region of Ukraine.

methodsWe gathered data on the unit costs of diabetes interventions in Poltava and estimated expenditure on diabetes care. We estimated the optimal combination of facility-based and outreach screening and investigated how additional funding could best be allocated to improve glucose control outcomes.

resultsOf the ~ 40,000 adults in diabetes care, only ~ 25% achieved sustained glucose control. Monitoring costs were higher for those who did not: by 10% for patients receiving non-pharmacological treatment, by 61% for insulin patients, and twice as high for patients prescribed oral treatment. Initiatives to improve treatment adherence (e.g. medication copayment schemes, enhanced adherence counseling) would address barriers along the care continuum and we estimate such expenditures may be recouped by reductions in patient monitoring costs. Improvements in case detection are also needed, with only around two-thirds of estimated cases having been diagnosed. Outreach screening campaigns could play a significant role: depending on how well-targeted and scalable such campaigns are, we estimate that 10-46% of all screening could be conducted via outreach, at a cost per positive patient identified of US$7.12-9.63.

conclusionsInvestments to improve case detection and treatment adherence are the most efficient interventions for improved diabetes control in Poltava. Quantitative tools provide essential decision support for targeting investment to close the gaps in care.

Indexed as

Blood GlucoseBlood Glucose Self-MonitoringCost-Benefit AnalysisCounselingDiabetes MellitusHumansMass ScreeningUkraineBlood GlucoseCare cascadesDiabetesModelingOptimizationService delivery

Identifiers

PMID32393341
PMCPMC7212677

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LicenceCC BY
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.