Cost-effectiveness of the Diabetes Care Protocol, a multifaceted computerized decision support diabetes management intervention that reduces cardiovascular risk.

Abstract

Objective: The Diabetes Care Protocol (DCP), a multifaceted computerized decision support diabetes management intervention, reduces cardiovascular risk of type 2 diabetes (DM2) patients. We performed a cost-effectiveness analysis of DCP from a Dutch health care perspective.

Research Design and Methods: A cluster randomized trial provided data of DCP versus usual care. The 1-year follow-up patient data were extrapolated using a modified Dutch micro-simulation diabetes model, computing individual lifetime, health related costs and health effects. Incremental costs and effectiveness (quality-adjusted life-years (QALY)) were estimated using multivariate generalized estimating equations to correct for practice-level clustering and confounding. Incremental cost-effectiveness ratios (ICER) were calculated and cost-effectiveness acceptability curves were created. Stroke costs were calculated separately. Subgroup analyses examined patients with and without cardiovascular disease (CVD+, CVD-).

Results: Excluding stroke, DCP patients lived longer (0.14 life-years, ns), experienced more QALYs (0.037, ns) and incurred higher total costs (€1,415, ns), resulting in an ICER of €38,243 per QALY gained. The likelihood of cost-effectiveness given a willingness-to-pay threshold of €20,000 per QALY gained is 30%. DCP had a more favorable effect on CVD+ patients (ICER=€14,814) than for CVD- patients (ICER=€121,285). Coronary heart disease costs were reduced (€-587 (p<0.05)).

Conclusions: DCP reduces cardiovascular risk, resulting in only a slight improvement in QALYs, lower CVD costs, but higher total costs, with a high cost-effectiveness ratio. Cost-effective care can be achieved by focusing on cardiovascular risk factors in DM2 patients with a history of cardiovascular disease.