title: Applying a private sector capitation model to the management of type 2 diabetes in the South African public sector: a cost-effectiveness analysis.
abstract: BACKGROUND
  Diabetes mellitus contributes substantially to the non-communicable disease burden in South Africa. The proposed National Health Insurance system provides an opportunity to consider the development of a cost-effective capitation model of care for patients with type 2 diabetes. The objective of the study was to determine the potential cost-effectiveness of adapting a private sector diabetes management programme (DMP) to the South African public sector.
  
  
  METHODS
  Cost-effectiveness analysis was undertaken with a public sector model of the DMP as the intervention and a usual practice model as the comparator. Probabilistic modelling was utilized for incremental cost-effectiveness ratio analysis with life years gained selected as the outcome. Secondary data were used to design the model while cost information was obtained from various sources, taking into account public sector billing.
  
  
  RESULTS
  Modelling found an incremental cost-effectiveness ratio (ICER) of ZAR 8 356 (USD 1018) per life year gained (LYG) for the DMP against the usual practice model. This fell substantially below the Willingness-to-Pay threshold with bootstrapping analysis. Furthermore, a national implementation of the intervention could potentially result in an estimated cumulative gain of 96 997 years of life (95% CI 71 073 years - 113 994 years).
  
  
  CONCLUSIONS
  Probabilistic modelling found the capitation intervention to be cost-effective, with an ICER of ZAR 8 356 (USD 1018) per LYG. Piloting the service within the public sector is recommended as an initial step, as this would provide data for more accurate economic evaluation, and would also allow for qualitative analysis of the programme.
authors.forename: Heinrich C
authors.initials: HC
authors.lastname: Volmink
authors.forename: Melanie Y
authors.initials: MY
authors.lastname: Bertram
authors.forename: Ruxana
authors.initials: R
authors.lastname: Jina
authors.forename: Alisha N
authors.initials: AN
authors.lastname: Wade
authors.affiliation: Priority Cost Effective Lessons for Systems Strengthening South Africa (PRICELESS SA), MRC/WITS Rural Public Health and Health Transitions Research Unit, Johannesburg, South Africa. karen.hofman@wits.ac.za.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Hofman
mesh_terms: D000328:Adult; D000368:Aged; D002204:Capitation Fee; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs; D017149:Private Sector; D017150:Public Sector; D013019:South Africa