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Health Serv Res. 2007 Dec;42(6 Pt 1):2174-93; discussion 2294-323.

The cost-effectiveness of improving diabetes care in U.S. federally qualified community health centers.

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  • 1The University of Chicago, 5841 S, Maryland Avenue, MC 2007, Chicago, IL 60637, USA.

Abstract

OBJECTIVE:

To estimate the incremental cost-effectiveness of improving diabetes care with the Health Disparities Collaborative (HDC), a national collaborative quality improvement (QI) program conducted in community health centers (HCs).

DATA SOURCES/STUDY SETTING:

Data regarding the impact of the Diabetes HDC program came from a serial cross-sectional follow-up study (1998, 2000, 2002) of the program in 17 Midwestern HCs. Data inputs for the simulation model of diabetes came from the latest clinical trials and epidemiological studies.

STUDY DESIGN:

We conducted a societal cost-effectiveness analysis, incorporating data from QI program evaluation into a Monte Carlo simulation model of diabetes.

DATA COLLECTION/EXTRACTION METHODS:

Data on diabetes care processes and risk factor levels were extracted from medical charts of randomly selected patients.

PRINCIPAL FINDINGS:

From 1998 to 2002, multiple processes of care (e.g., glycosylated hemoglobin testing [HbA1C] [71-->92 percent] and ACE inhibitor prescribing [33-->55 percent]) and risk factor levels (e.g., 1998 mean HbA1C 8.53 percent, mean difference 0.45 percent [95 percent confidence intervals -0.72, -0.17]) improved significantly. With these improvements, the HDC was estimated to reduce the lifetime incidence of blindness (17-->15 percent), end-stage renal disease (18-->15 percent), and coronary artery disease (28-->24 percent). The average improvement in quality-adjusted life year (QALY) was 0.35 and the incremental cost-effectiveness ratio was $33,386/QALY.

CONCLUSIONS:

During the first 4 years of the HDC, multiple improvements in diabetes care were observed. If these improvements are maintained or enhanced over the lifetime of patients, the HDC program will be cost-effective for society based on traditionally accepted thresholds.

PMID:
17995559
[PubMed - indexed for MEDLINE]
PMCID:
PMC2151395
Free PMC Article
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