title: Cost-effectiveness of implementing the chronic care model for diabetes care in a military population.
abstract: BACKGROUND
  Applying the chronic care model (CCM) for diabetes management helps improve health outcomes and patient care. The CCM was implemented at U.S. Air Force Wilford Hall Medical Center through the Diabetes Outreach Clinic (DOC) in 2006, but its cost-effectiveness in this setting is unknown.
  
  
  METHODS
  We constructed a Markov decision model to estimate DOC cost-effectiveness compared with usual care (UC) over a 20-year period. Based on empirical, post-intervention demographic and clinical data, we applied United Kingdom Prospective Diabetes Study risk equations to predict long-term probabilities of developing microvascular or macrovascular complications. Health care system and societal perspectives were considered, discounting costs and benefits at 3% annually. Intervention costs and outcomes were obtained from military data, while other costs, disease progression data, and utilities were drawn from published literature.
  
  
  RESULTS
  From a health care system perspective, the DOC cost $45,495 per quality-adjusted life-year (QALY) compared with UC; from a societal perspective, the DOC compared with UC cost $42,051/QALY (when the model started with the uncomplicated diabetes cohort), $61,243/QALY (when starting with the DOC cohort), or $61,813/QALY (when starting with the UC cohort). In one-way sensitivity analyses, results were most sensitive to yearly costs for specialty care visits. In probabilistic sensitivity analysis, the DOC was favored in 51% of model iterations using an acceptability threshold of $50,000/QALY and in 72% at a threshold of $100,000/QALY.
  
  
  CONCLUSIONS
  The DOC strategy for diabetes care, performed with the CCM methodology in a military population, appears to be economically reasonable compared with UC.
authors: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. shk26@pitt.edu
authors: Shihchen
authors: S
authors: Kuo
authors: Cindy L
authors: CL
authors: Bryce
authors: Janice C
authors: JC
authors: Zgibor
authors: Donna L
authors: DL
authors: Wolf
authors: Mark S
authors: MS
authors: Roberts
authors: Kenneth J
authors: KJ
authors: Smith
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008889:Military Personnel; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D012306:Risk; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014481:United States