Byline: Toshiki. Maeda, Akira. Babazono, Takumi. Nishi, Hiroki. Miyazaki, Kazumitsu. Tamaki, Masashi. Fujii
Introduction: The aim of this study was to quantify the effects of diabetes with pharmacotherapy-treated breast cancer on care resource use. Materials and Methods: The study was designed as a single institutional retrospective cohort study using hospital administrative data. The subjects were 152 patients admitted to a hospital from 2008 to 2012 diagnosed with breast cancer, and who underwent pharmacotherapy. We identified diabetes group and nondiabetes group in addition to other variables and quantified the effects of diabetes with breast cancer patients undergoing pharmacotherapy on care resource use, using a multilevel linear regression model. Results: Diabetes was significantly correlated to both longer length of stay (coefficient standard error: 0.75 [0.19], P < 0.001) and higher total hospital charge (0.72 [0.18], P < 0.001), controlled for age, pharmacotherapeutic agent, steroid use, admission route, procedures, and postpharmacotherapy events. Conclusion: This study showed that diabetes itself is a risk factor for greater care resource use after controlling for confounding factors. Pharmacotherapy for breast cancer may influence poor glycemic control, thus leading to greater care resource use. Early detection and careful monitoring of diabetes are essential in malignancy to eliminate this burden on the health care system.
With an aging population, diabetes has been increasing in Japan. The number of diabetic, prediabetic, and total diabetic patients have been estimated at 9.5 million, 11 million, and 20.5 million, respectively.[sup] Thus, it has been suggested that possibly one-quarter of the Japanese population has diabetes or glucose intolerance. It has been reported that those with diabetes incur greater health care costs than those without diabetes;[sup] therefore, an increase in the number of diabetic patients will escalate health care costs in Japan.
In addition, the number of patients with malignancy has been increasing because of the aging population.[sup] In particular, the number of patients with breast cancer has increased remarkably,[sup] and breast cancer is, at present, the most prevalent cancer among women in Japan.[sup] It has been reported that hyperglycemia is a risk factor for breast cancer,[sup] for which the main therapies are surgery, pharmacotherapy, and radiotherapy. It is well-known that hyperglycemia in surgical patients delays wound healing [sup], and increases the likelihood of postsurgical infection [sup], and cardiovascular events.[sup], Some recent studies have reported that pharmacotherapy, including hormonal and chemotherapeutic agents for breast cancer, may influence poor glycemic control;[sup], thus, pharmacotherapy for breast cancer with diabetes could be a further burden for the Japanese health care system. However, there have been few studies examining the effects on care resource use of diabetes with malignancy.
The aim of this study was to quantify the effects of diabetes with pharmacotherapy-treated breast cancer on care resource use.
Materials and Methods
Definition of subjects
We used hospital administrative data, Diagnosis Procedure Combination (DPC) data from a single institute. This hospital is a 550-bed emergency center and is a core institute in the region. The DPC system is adopted mainly by acute health care facilities, and...