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Health Economic Evaluation of a Strict Glucose Control Guideline Implemented Using Point-of-Care Testing in Three Intensive Care Units in The Netherlands

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Abstract

Background

Point-of-care testing of blood glucose (BG-POCT) is essential for safe and effective insulin titrations in critically ill patients under glucose control with insulin. The costs associated with this practice are considered substantial, especially when more frequent blood glucose (BG) testing is needed, as with more strict glucose control (SGC) aiming for lower BG levels.

Objective

The objective of this study was to estimate, from a hospital perspective, the incremental cost effectiveness of an SGC guideline, aiming for BG levels of 4.4–6.1 mmol/L, compared to the situation before implementation of that guideline (aiming for BG levels <8.3 mmol/L), both using BG–POCT.

Methods

This is a secondary analysis of a guideline implementation project aiming for implementation of a guideline of SGC in three intensive care units in The Netherlands. A Markov model including the four health states ‘target glucose’, ‘hyperglycaemia’ (defined as BG levels >6.1 mmol/L), ‘hypoglycaemia’ (defined as BG levels <4.4 mmol/L) and ‘in-hospital death’ was developed to compare expected costs, number of patients within target and number of life-years saved before and after implementation of the SGC guideline. The effectiveness estimates are based on empirical data from 3195 patients 12 and 24 months before and after implementation of the guideline, respectively. All costs have been converted to price year 2013, and are estimated based on hospital data, the literature and available price lists.

Results

The number of BG–POCT increased from 4.8 [interquartile range (IQR) 2.6–6.7] to 8.0 [IQR 4.1–11.2] per patient per day, accruing 58 % higher costs for BG–POCT (€13.56 vs. €8.57 per patient) in the SGC protocol versus the situation before implementation. When taking total hospital costs and clinical effects into account, implementation of the SGC guideline increased total hospital costs per patient by 1.8 %, i.e. €355 (from €20,617 to €20,972) during the inpatient stay, while the number of patients in target glucose levels increased by 1.4 % (i.e. from 881 to 895 per 1000 patients). This translates to an incremental cost-effectiveness ratio of €25 per additional patient within the target glucose level. The model outcomes are most sensitive to changes in ICU length of stay.

Conclusion

The increase in the number of patients and time within target glucose levels is achieved with a small increase in total direct hospital costs.

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Conflict of interest

The implementation study, previously published by Schultz et al. 2012, was supported by a grant from the Netherlands Organization for Health Research and Development [11]. The health economic model development was supported by a grant from Roche Diagnostics International Ltd. (represented by Ms. Mulder), of which Monteban Value Services (represented by Ms. Monteban) and PANAXEA (represented by Ms. Kip and Dr. Steuten) were the beneficiaries. All other authors have no conflicts of interest to declare.

Author contributions

Authors van Hooijdonk, Steuten, Kip, Monteban, Mulder, Spronk and Schultz made substantial contributions to the conception and planning of the work that led to the manuscript and to the acquisition, analysis and interpretation of data. Authors van Braam Houckgeest, van der Sluijs and Abu-Hanna made substantial contributions to the conception and planning of the work that led to the manuscript and to the interpretation of data. Authors van Hooijdonk, Steuten, Kip and Monteban drafted the paper and critically revised the manuscript for important intellectual content. Authors Mulder, Spronk, Schultz, van Braam Houckgeest, van der Sluijs and Abu-Hanna critically revised the manuscript for important intellectual content. All authors approved the final submitted version of the paper. Dr. Steuten is guarantor for the overall content.

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Authors and Affiliations

  1. Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Roosmarijn T. M. van Hooijdonk, Peter E. Spronk & Marcus J. Schultz

  2. PANAXEA B.V., Enschede, The Netherlands

    Lotte M. G. Steuten & Michelle M. A. Kip

  3. Fred Hutchinson Cancer Research Center, Hutchinson Institute for Cancer Outcomes Research, Seattle, WA, USA

    Lotte M. G. Steuten

  4. Monteban Value Services, Amerongen, The Netherlands

    Helma Monteban

  5. Roche Diagnostics International Ltd., Rotkreuz, Switzerland

    Marianne R. Mulder

  6. Department of Intensive Care, Tergooi Hospitals, Location Blaricum, Blaricum, The Netherlands

    Floris van Braam Houckgeest

  7. Department of Intensive Care Medicine, Medical Center Haaglanden, The Hague, The Netherlands

    Johannes P. van der Sluijs

  8. Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Ameen Abu-Hanna

  9. Department of Intensive Care, Gelre Hospitals, Location Lukas, Apeldoorn, The Netherlands

    Peter E. Spronk

  10. Laboratory of Experimental Intensive Care and Anesthesiology (L E I C A), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Marcus J. Schultz

  11. Department of Health Technology and Services Research, MIRA, University of Twente, Enschede, The Netherlands

    Michelle M. A. Kip

Authors
  1. Roosmarijn T. M. van Hooijdonk
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  2. Lotte M. G. Steuten
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  3. Michelle M. A. Kip
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  4. Helma Monteban
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  5. Marianne R. Mulder
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  6. Floris van Braam Houckgeest
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  7. Johannes P. van der Sluijs
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  8. Ameen Abu-Hanna
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  9. Peter E. Spronk
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  10. Marcus J. Schultz
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Corresponding author

Correspondence to Lotte M. G. Steuten.

Appendix

Appendix

See Table 4.

Table 4 Results of one-way sensitivity analysis
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van Hooijdonk, R.T.M., Steuten, L.M.G., Kip, M.M.A. et al. Health Economic Evaluation of a Strict Glucose Control Guideline Implemented Using Point-of-Care Testing in Three Intensive Care Units in The Netherlands. Appl Health Econ Health Policy 13, 399–407 (2015). https://doi.org/10.1007/s40258-015-0174-5

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  • DOI: https://doi.org/10.1007/s40258-015-0174-5

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