title: Cost-effectiveness of a quality improvement collaborative focusing on patients with diabetes.
abstract: OBJECTIVE
  To investigate the lifelong health effects, costs, and cost-effectiveness of a quality improvement collaborative focusing on improving diabetes management in an integrated care setting.
  
  
  METHODS
  Economic evaluation from a healthcare perspective with lifetime horizon alongside a nonrandomized, controlled, before-after study in the Netherlands. Analyses were based on 1861 diabetes patients in 6 intervention and 9 control regions, representing 37 general practices and 13 out-patient clinics. Change in the United Kingdom Prospective Diabetes Study score, remaining lifetime, and costs per quality-adjusted life year gained were calculated. Probabilistic life tables were constructed using the United Kingdom Prospective Diabetes Study risk engine, a validated diabetes model, and nonparametric bootstrapping of individual patient data.
  
  
  RESULTS
  Annual United Kingdom Prospective Diabetes Study risk scores reduced for cardiovascular events (hazard ratio: 0.83 and 0.98) and cardiovascular mortality (hazard ratio: 0.78 and 0.88) for men and women, respectively. Life expectancy improved by 0.97 and 0.76 years for men and women, and quality-adjusted life years by 0.44 and 0.37, respectively. Higher life expectancy in the intervention group increased lifelong costs by &OV0556;860 for men and &OV0556;645 for women. Initial program costs were about &OV0556;22 per patient. The incremental costs per quality-adjusted life year were &OV0556;1937 for men and &OV0556;1751 for women compared with usual care costs. There is a probability >95% that the collaborative is cost-effective, using a threshold of &OV0556;20,000 per quality-adjusted life year.
  
  
  CONCLUSIONS
  Optimizing integrated and patient-centered diabetes care through a quality-improvement collaborative is cost-effective compared with usual care.
authors.affiliation: Dutch Institute for Healthcare Improvement, Utrecht, The Netherlands. l.schouten@cbo.nl
authors.forename: Loes M T
authors.initials: LM
authors.lastname: Schouten
authors.forename: Louis W
authors.initials: LW
authors.lastname: Niessen
authors.forename: Jeroen W A M
authors.initials: JW
authors.lastname: van de Pas
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
authors.forename: Marlies E J L
authors.initials: ME
authors.lastname: Hulscher
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics / Q000458:organization & administration*; D000787:Angina Pectoris / Q000191:economics / Q000517:prevention & control; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics* / Q000517:prevention & control / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000191:economics / Q000517:prevention & control; D003928:Diabetic Nephropathies / Q000191:economics / Q000517:prevention & control; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000191:economics / Q000458:organization & administration*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years