Cost-effectiveness of Diabetes Self-management Programs in Community Primary Care Settings
Cost-effectiveness of Diabetes Self-management Programs in Community Primary Care Settings
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DOI：
10.1177/0145721709340931
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发表时间：
2009-09-01
影响因子：
3.9
通讯作者：
Kilpatrick, Kerry E.
中科院分区：
文献类型：
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作者：
Brownson, Carol A.;Hoerger, Thomas J.;Kilpatrick, Kerry E.
目的本研究的目的是评估现实世界社区初级保健环境中糖尿病自我管理项目的成本效益。估计包括疾病进展的终生减少、不良事件的成本和生活质量的提高。方法：临床结果和成本基于罗伯特·伍德·约翰逊基金会的糖尿病倡议项目，该项目在存在显著健康差异的弱势地区的初级保健和社区环境中实施。项目结果被用作马尔可夫模拟模型的输入，以估计自我管理干预的长期效果。采用了卫生系统的观点。模拟模型估计，干预措施确实减少了3385美元的折扣终身治疗和并发症成本，但这被实施干预措施并在随后几年保持其效果的15031美元成本所抵消。该干预措施估计可减少长期并发症，导致剩余生命年和质量调整生命年（QALYs）的增加。增量成本效益比率为39563美元/质量年，远低于5万美元/质量年的一般基准。敏感性分析在不同的假设条件下检验了模型估计的稳健性。该模型通常预测可接受的成本效益比率。结论从卫生系统的角度来看，2型糖尿病的自我管理方案是具有成本效益的，因为认识到减少长期并发症可以节省成本。这些发现可以证明在不同的环境中增加对有效自我管理项目的补偿是合理的。
PurposeThe purpose of this study is to estimate the cost-effectiveness of diabetes self-management programs in real-world community primary care settings. Estimates incorporated lifetime reductions in disease progression, costs of adverse events, and increases in quality of life.MethodsClinical results and costs were based on programs of the Diabetes Initiative of the Robert Wood Johnson Foundation, implemented in primary care and community settings in disadvantaged areas with notable health disparities. Program results were used as inputs to a Markov simulation model to estimate the long-term effects of self-management interventions. A health systems perspective was adopted.ResultsThe simulation model estimates that the intervention does reduce discounted lifetime treatment and complication costs by $3385, but this is more than offset by the $ 15 031 cost of implementing the intervention and maintaining its effects in subsequent years. The intervention is estimated to reduce long-term complications, leading to an increase in remaining life-years and quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio is $ 39 563/QALY, well below a common benchmark of $ 50 000/QALY. Sensitivity analyses tested the robustness of the model's estimates under various alternative assumptions. The model generally predicts acceptable cost-effectiveness ratios.ConclusionsSelf-management programs for type 2 diabetes are cost-effective from a health systems perspective when the cost savings due to reductions in long-term complications are recognized. These findings may justify increased reimbursement for effective self-management programs in diverse settings.