A cost effectiveness study of integrated care in health services delivery: a diabetes program in Australia
Date
2008-10-06
Authors
McRae, Ian Stewart
Butler, J. R. G
Sibthorpe, Beverly
Ruscoe, Warwick
Snow, Jill
Rubiano, Dhigna
Gardner, Karen
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BioMed Central
Abstract
BACKGROUND: Type 2 diabetes is rapidly growing as a proportion of the disease burden in Australia as
elsewhere. This study addresses the cost effectiveness of an integrated approach to assisting general
practitioners (GPs) with diabetes management. This approach uses a centralized database of clinical data
of an Australian Division of General Practice (a network of GPs) to co-ordinate care according to national
guidelines.
METHODS: Long term outcomes for patients in the program were derived using clinical parameters after
5 years of program participation, and the United Kingdom Prospective Diabetes Study (UKPDS)
Outcomes Model, to project outcomes for 40 years from the time of diagnosis and from 5 years postdiagnosis.
Cost information was obtained from a range of sources. While program costs are directly
available, and costs of complications can be estimated from the UKPDS model, other costs are estimated
by comparing costs in the Division with average costs across the state or the nation. The outcome and
cost measures are used derive incremental cost-effectiveness ratios.
RESULTS: The clinical data show that the program is effective in the short term, with improvement or no
statistical difference in most clinical measures over 5 years. Average HbA1c levels increased by less than
expected over the 5 year period. While the program is estimated to generate treatment cost savings,
overall net costs are positive. However, the program led to projected improvements in expected life years
and Quality Adjusted Life Expectancy (QALE), with incremental cost effectiveness ratios of $A8,106 per
life-year saved and $A9,730 per year of QALE gained.
CONCLUSIONS: The combination of an established model of diabetes progression and generally available
data has provided an opportunity to establish robust methods of testing the cost effectiveness of a
program for which a formal control group was not available. Based on this methodology, integrated health
care delivery provided by a network of GPs improved health outcomes of type 2 diabetics with acceptable
cost effectiveness, which suggests that similar outcomes may be obtained elsewhere.
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Keywords
Keywords: hemoglobin A1c; oral antidiabetic agent; glycosylated hemoglobin; adult; article; Australia; controlled study; cost effectiveness analysis; data base; general practice; general practitioner; health care delivery; health program; health service; human; lon
Citation
BMC Health Services Research 8.205 (2008)
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BMC Health Services Research
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Journal article
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