A cost effectiveness study of integrated care in health services delivery: a diabetes program in Australia.
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 post-diagnosis. 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.
Australian Centre for Economic Research on Health, The Australian National University, Canberra, Australia. ian.s.mcrae@anu.edu.au
Ian S
IS
McRae
James R G
JR
Butler
Beverly M
BM
Sibthorpe
Warwick
W
Ruscoe
Jill
J
Snow
Dhigna
D
Rubiano
Karen L
KL
Gardner
D000368:Aged; D019090:Case Management / Q000191:economics*; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D019468:Disease Management; D036262:Empirical Research; D005194:Family Practice / Q000191:economics / Q000458:organization & administration*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D017146:Models, Organizational; D009517:New South Wales; D017063:Outcome Assessment, Health Care / Q000191:economics*; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years
D006442:Glycated Hemoglobin