RESUMEN
INTRODUCTION: Le diabète mellitus est une maladie chronique qui se caractérise par une hyperglycémie, qui apparaît lorsque l'organisme est incapable de sécréter une quantité suffisante d'insuline, en présence ou non de résistance à celle-ci. Selon les estimations publiées par l'Association canadienne du diabète, environ 3,4 millions de Canadiens étaient atteints de diabète, en 2015. Parmi les différentes formes existantes, le diabète de type 2 est de loin le plus répandu. L'autosurveillance glycémique (ASG) est l' une des approches offertes pour aider la personne atteinte de diabète à contrôler sa glycémie. L'utilisation de bandelettes et d'un glucomètre permet de mesurer la glycémie capillaire et d'ajuster, si nécessaire, les habitudes de vie ou la médication. En 2015, les dépenses liées à la classe des bandelettes ont totalisé près de 104 millions de dollars et concerné environ 285 000 personnes couvertes par le régime public d'assurance médicaments (RPAM) du Québec. Or, d'après les mesures instaurées dans les autres provinces anadiennes, près de 30 % des utilisateurs assurés au RPAM et non traités à l'insuline semblent en faire un usage non optimal, ce qui entraîne des coûts pour le réseau de la santé et des services sociaux, sans gain de santé pour les utilisateurs. Les autres provinces canadiennes, à l'exception du Québec, ont mis en place des mesures encadrant le remboursement des bandelettes afin de favoriser un usage optimal et de limiter les coûts. C'est dans ce contexte
INTRODUCTION: Diabetes mellitus is a chronic disease characterized by hyperglycemia, which occurs when the body is unable to produce sufficient insulin, whether or not in the presence of insulin resistance. According to the estimates published by the Canadian Diabetes Association (CDA), around 3.4 million Canadians lived with diabetes in 2015. Of the different existing forms, type 2 diabetes is by far the most widespread. Self-monitoring of blood glucose (SMBG) is one of the approaches offered to help people with diabetes control their blood glucose (BG) levels. The use of BG test strips and a meter helps to measure capillary glycemia and to make any necessary lifestyle or medication adjustments. In 2015, expenditures tied to the class of BG test strips totalled nearly $104 million and concerned around 285,000 people covered by Québec's public prescription drug insurance plan (PPDIP). Based on the measures introduced in the other Canadian provinces, about 30% of users covered by the PPDIP and not treated with insulin seem to make non-optimal use of them, which leads to costs for the health and social services system, without health benefits for users. The other Canadian provinces, except for Québec, have introduced measures governing the reimbursement of BG test strips to encourage their optima
Asunto(s)
Automonitorización de la Glucosa Sanguínea/métodos , Diabetes Mellitus/sangre , Política de Salud , Evaluación en Salud/economía , Tiras Reactivas/economía , Mecanismo de Reembolso/economía , Evaluación de la Tecnología BiomédicaRESUMEN
BACKGROUND: Diagnosis of spontaneous bacterial peritonitis (SBP) is currently based on ascitic cell counting, but there is a need for a more simple and rapid diagnostic tool. The objectives of this study are to evaluate the accuracy of reagent strips in diagnosing SBP and compare their costs with total and differential cell counts. PATIENTS AND METHODS: 71 cirrhotic in- and outpatients were consecutively included (159 samples). Spontaneous bacterial peritonitis was defined as neutrophil cells >or= 250/microL. The cutoff values for each reagent strip were defined by a receiver operating characteristic (ROC) curve. Sensitivity (S), Specificity (Sp), Positive and Negative Predictive Values (PPV and NPV), Accuracy (Ac) and cost-effectiveness (US$) in comparison to cell count exam were calculated. RESULTS: Spontaneous bacterial peritonitis was diagnosed in 17 patients (23.9%), 11 of them with positive culture (64.7%). The best cutoff points found in ROC curves were 1+ for Multistix 10 SG and ca. 75 for Choiceline 10 (Multistix 10 SG S = 80%, Sp = 98.5%, PPV = 90.9%, NPV = 96.2%, Ac = 95%; Choiceline 10 S = 76.9%, Sp = 97.7%, PPV = 87%, NPV = 95.6%, Ac = 94%). In terms of cost-effectiveness by cost/accuracy, cell count was 41.5, Multistix 10 SG 0.57, and Choiceline 10, 0.19 (P < 0.001). CONCLUSION: Reagent strips are a useful tool for diagnosing SBP in cirrhotic patients, but they have some limitations. Strips are especially indicated when total and differential cell counts are not quickly available or sometimes unavailable. They are also indicated as screening test in emergency rooms to anticipate the diagnosis of SBP and allow its early treatment. It's an interesting option in developing countries.