Cost-effectiveness of the diabetes care protocol, a multifaceted computerized decision support diabetes management intervention that reduces cardiovascular risk.
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.


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 (euro 1,415, P = NS), resulting in an ICER of euro 38,243 per QALY gained. The likelihood of cost-effectiveness given a willingness-to-pay threshold of euro 20,000 per QALY gained is 30%. DCP had a more favorable effect on CVD+ patients (ICER = euro 14,814) than for CVD- patients (ICER = euro 121,285). Coronary heart disease costs were reduced (euro-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.
Cleveringa
Frits G W
FG
Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands. f.g.w.cleveringa@umcutrecht.nl
Welsing
Paco M J
PM
van den Donk
Maureen
M
Gorter
Kees J
KJ
Niessen
Louis W
LW
Rutten
Guy E H M
GE
Redekop
William K
WK
D000368:Aged; D000671:Amputation, Surgical / Q000191:economics; D000787:Angina Pectoris / Q000191:economics / Q000517:prevention & control; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000191:economics*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D003925:Diabetic Angiopathies / Q000191:economics / Q000517:prevention & control*; D003928:Diabetic Nephropathies / Q000191:economics / Q000517:prevention & control; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000191:economics / Q000517:prevention & control; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000517:prevention & control; D009426:Netherlands; D011788:Quality of Life; D012307:Risk Factors; D013813:Therapy, Computer-Assisted
D007004:Hypoglycemic Agents