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- Title
Cost-Effectiveness of the Diabetes Care Protocol, a Multifaceted Computerized Decision Support Diabetes Management Intervention That Reduces Cardiovascular Risk.
- Authors
Cleveringa, Frits G. W.; Welsing, Paco M. J.; Van Den Donk, Maureen; Gorier, Kees J.; Niessen, Louis W.; Rutten, Guy E.H.M.; Redekop, William K.
- Abstract
OBJECTIVE -- The Diabetes Care Protocol (DCP), a multifaceted computerized decision support diabetes management intervention, reduces cardiovascular risk of type 2 diabetic patients. We performed a cost-effectiveness analysis of DCP from a Dutch health care perspective. RESEARCH DESIGN AND METHODS -- A cluster randomized trial provided data of DCP versus usual care. The 1-year follow-up patient data were extrapolated using a modified Dutch microsimulation diabetes model, computing individual lifetime health-related costs, and health effects. Incremental costs and effectiveness (quality-adjusted life-years [QALYs]) were estimated using multivariate generalized estimating equations to correct for practice-level clustering and confounding. Incremental cost-effectiveness ratios (ICERs) were calculated and cost-effectiveness acceptability curves were created. Stroke costs were calculated separately. Subgroup analyses examined patients with and without cardiovascular disease (CVD+ or CVD--patients, respectively). RESULTS -- Excluding stroke, DCP patients lived longer (0.14 life-years, P = NS), experienced more QALYs (0.037, P = NS), and incurred higher total costs (€1,415, P = NS), resulting in an ICER of €38,243 per QALY gained. The likelihood of cost-effectiveness given a willingness-to-pay threshold of €20,000 per QALY gained is 30%. DCP had a more favorable effect on CVD + patients (ICER = €14,814) than for CVD- patients (ICER = €121,285). Coronary heart disease costs were reduced (€-587, P < 0.05). CONCLUSIONS -- DCP reduces cardiovascular risk, resulting in only a slight improvement in QALYs, lower CVD costs, but higher total costs, with a high cost-effectiveness ratio. Cost-effective care can be achieved by focusing on cardiovascular risk factors in type 2 diabetic patients with a history of CVD.
- Subjects
MEDICAL care costs; COST analysis; WILLINGNESS to pay; QUALITY-adjusted life years; TREATMENT of diabetes; HEART disease risk factors; MEDICAL protocols
- Publication
Diabetes Care, 2010, Vol 33, Issue 2, p258
- ISSN
0149-5992
- Publication type
Article
- DOI
10.2337/dc09-1232