title: Cost-Effectiveness of Disease Management Programs for Cardiovascular Risk and COPD in The Netherlands.
abstract: BACKGROUND
  Disease management programs (DMPs) for cardiovascular risk (CVR) and chronic obstructive pulmonary disease (COPD) are increasingly implemented in The Netherlands to improve care and patient's health behavior.
  
  
  OBJECTIVE
  The aim of this study was to provide evidence about the (cost-) effectiveness of Dutch DMPs as implemented in daily practice.
  
  
  METHODS
  We compared the physical activity, smoking status, quality-adjusted life-years, and yearly costs per patient between the most and the least comprehensive DMPs in four disease categories: primary CVR prevention, secondary CVR prevention, both types of CVR prevention, and COPD (N = 1034). Propensity score matching increased comparability between DMPs. A 2-year cost-utility analysis was performed from the health care and societal perspectives. Sensitivity analysis was performed to estimate the impact of DMP development and implementation costs on cost-effectiveness.
  
  
  RESULTS
  Patients in the most comprehensive DMPs increased their physical activity more (except for primary CVR prevention) and had higher smoking cessation rates. The incremental QALYs ranged from -0.032 to 0.038 across all diseases. From a societal perspective, the most comprehensive DMPs decreased costs in primary CVR prevention (certainty 57%), secondary CVR prevention (certainty 88%), and both types of CVR prevention (certainty 98%). Moreover, the implementation of comprehensive DMPs led to QALY gains in secondary CVR prevention (certainty 92%) and COPD (certainty 69%).
  
  
  CONCLUSIONS
  The most comprehensive DMPs for CVR and COPD have the potential to be cost saving, effective, or cost-effective compared with the least comprehensive DMPs. The challenge for Dutch stakeholders is to find the optimal mixture of interventions that is most suited for each target group.
authors.affiliation: Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK; Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands. Electronic address: apostolos.tsiachristas@dph.ox.ac.uk.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tsiachristas
authors.affiliation: Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Burgers
authors.affiliation: Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Maureen P M H
authors.initials: MP
authors.lastname: Rutten-van Mölken
mesh_terms: D000041:Absenteeism; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D019468:Disease Management; D015444:Exercise; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009426:Netherlands / Q000453:epidemiology; D011314:Preventive Health Services / Q000191:economics* / Q000379:methods*; D011320:Primary Health Care / Q000458:organization & administration; D057216:Propensity Score; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000517:prevention & control*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000191:economics / Q000379:methods; D014195:Travel / Q000191:economics
keywords: COPD; cardiovascular disease; costs; effectiveness; integrated care