title: The cost-effectiveness of primary care for Indigenous Australians with diabetes living in remote Northern Territory communities.
abstract: OBJECTIVE
  To evaluate the costs and health outcomes associated with primary care use by Indigenous people with diabetes in remote communities in the Northern Territory.
  
  
  METHODS
  A population-based retrospective cohort study from 1 January 2002 to 31 December 2011 among Indigenous NT residents ≥ 15 years of age with diabetes who attended one of five hospitals or 54 remote clinics in the NT.
  
  
  METHODS
  Hospitalisations, potentially avoidable hospitalisations (PAH), mortality and years of life lost (YLL). Variables included disease stage (new, established or complicated cases) and primary care use (low, medium or high).
  
  
  RESULTS
  14 184 patients were eligible for inclusion in the study. Compared with the low primary care use group, the medium-use group (patients who used primary care 2-11 times annually) had lower rates of hospitalisation, lower PAH, lower death rates and fewer YLL. Among complicated cases, this group showed a significantly lower mean annual hospitalisation rate (1.2 v 6.7 per person [P < 0.001]) and PAH rate (0.72 v 3.64 per person [P < 0.001]). Death rate and YLL were also significantly lower (1.25 v 3.77 per 100 population [P < 0.001] and 0.29 v 1.14 per person-year [P < 0.001], respectively). The cost of preventing one hospitalisation for diabetes was $248 for those in the medium-use group and $739 for those in the high-use group. This compares to $2915, the average cost of one hospitalisation.
  
  
  CONCLUSIONS
  Improving access to primary care in remote communities for the management of diabetes results in net health benefits to patients and cost savings to government.
authors.affiliation: Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, NT, Australia. s.thomas@flinders.edu.au.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Thomas
authors.affiliation: Health Gains Planning Branch, Department of Health, Darwin, NT, Australia.
authors.forename: Yuejen
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Health Gains Planning Branch, Department of Health, Darwin, NT, Australia.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Guthridge
authors.affiliation: Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, NT, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Wakerman
mesh_terms: D001315:Australia / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000208:ethnology / Q000628:therapy*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D009017:Morbidity / Q000639:trends; D044382:Population Groups; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends