Cost-effectiveness of the Diabetes Care Protocol, a multifaceted computerized decision support diabetes management intervention that reduces cardiovascular risk

Cleveringa, Frits G. W., Welsing, Paco M. J., van den Donk, Maureen, Gorter, Kees J., Niessen, Louis W., Rutten, Guy E. H. M. and Redekop, William K. (2010) Cost-effectiveness of the Diabetes Care Protocol, a multifaceted computerized decision support diabetes management intervention that reduces cardiovascular risk. Diabetes Care, 33 (2). pp. 258-263. ISSN 0149-5992

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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.

Item Type:	Article
Uncontrolled Keywords:	sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Health Economics
Depositing User:	EPrints Services
Date Deposited:	25 Nov 2010 11:12
Last Modified:	06 Feb 2025 01:58
URI:	https://ueaeprints.uea.ac.uk/id/eprint/14338
DOI:	10.2337/dc09-1232

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