Objectives
To assess the efficacy and economic impact, in terms of direct medical costs (DMC), of treating by metformin plus glibenclamide (MG) type II Diabetes Mellitus (T2DM) outpatients in a second level hospital during the COVID19 pandemic in Ecuador.
Methods
Adult T2DM patients treated with MG combination from January to December 2021 were included. Patient chart’s information was collected using a Capture Report Form to evaluate the efficacy and management of these outpatients. Drug and services prices were taken from the National Public Procurement Service, while medical cost estimations were obtained from the National Fare System (2014 and 2019). A Microsoft Excel budget model was developed to calculate the DMC. The study was approved by the Institutional Review Board Ethics Committee.
Results
Thirty-Nine patients were included in the study. After a year of MG treatment, fasting glucose (-58.8 mg/dl; 95% CI -19.7 to -97.9 mg/dl; P=0.004) and glycosylated hemoglobin levels (-1.05%; 95% CI -0.16 to -1.93%; P=0.02) significantly decreased. The MG outpatient treatment had a total annual cost of 110,634.81 USD, yielding an amount of 2,836.79 USD per patient (PP). Medical consultations amounted 1,817.72 USD (205,23 USD PP) and 84.5% of them were for diabetic control (5.5 ± 2.7 consultations PP/year). All patients required hospitalization and emergency care at least once, with corresponding costs of 77,812.73 USD (1,995.20 USD PP) and 3,448.56 USD (88.42 USD PP), respectively.
Conclusions
MG significantly reduced fasting glucose and HbA1c levels, but not according to international recommendations. The management of T2DM patients during COVID-19 had a major economic impact mainly due to complications and prolonged hospital stays.