Long-term cost-utility analysis of a multidisciplinary primary care diabetes management program in Ontario
O'Reilly D., Hopkins R., Blackhouse G., Clarke P., Hux J., Tarride JE., Dolovich L., Goeree R.
OBJECTIVES: To estimate the cost-effectiveness of a multidisciplinary diabetes management program using the Ontario Diabetes Economic Model (ODEM). METHODS: Using an Ontario-specific United Kingdom Prospective Diabetes Study Outcomes Model, changes in risk factors (e.g. glycosylated hemoglobin) were used to predict event rates for diabetes-related complications, costs and expected quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios were calculated based on the cost of the program, projected cost and effectiveness over a lifetime. The base case assumed a 1-year treatment effect, 3% discount rate and 40-year time horizon. RESULTS: The ODEM estimated that improvements in risk factors prevented 16.2/1000 deaths and 15.5/1000 myocardial infarctions, and led to a 50% relative risk reduction in first amputations. The lifetime incremental cost per QALY gained in the base case was $5992. CONCLUSION: Short-term outcomes were improved, translating into avoidance of downstream complications; thus, the increased costs of program implementation were partly offset. Overall, the program represents a cost-effective method for managing type 2 diabetes.