Cost Effectiveness of Diabetes Mellitus Management Programs
A Health Plan Perspective
First Online: 07 October 2012 DOI:
10.2165/00115677-200311070-00004 Cite this article as: Gilmer, T. & O’Connor, P.J. Dis-Manage-Health-Outcomes (2003) 11: 439. doi:10.2165/00115677-200311070-00004 Abstract
In this article, we provide a practical and systematic framework to evaluate the cost effectiveness of health plans’ investments towards improvements in diabetes care. Through a literature search of PubMed and our own review, we identified research studies providing evidence on the cost effectiveness of diabetes management. Published and unpublished studies that address these issues are reviewed and synthesized in this paper, with the goal of assisting resource allocation decision makers in selecting the most appropriate and effective diabetes care improvement strategies available to meet the needs of specific care delivery systems and patient populations. We summarize this evidence as it relates to four areas: (i) healthcare provider characteristics, the provider-patient relationship, and systems of care; (ii) clinical care decisions including the management of blood glucose, blood pressure, and cholesterol; (iii) models for improved delivery of care; and (iv) the health plan perspective regarding returns on investment.
Research data indicate that cost effectiveness varies by clinical domain. Blood pressure control, use of aspirin, and influenza and pneumococcal immunizations are cost saving in adults with diabetes across a wide range of ages and types of patients. Lipid control is most cost effective between the ages of 45–85 years, while the cost effectiveness of intensified glycemic control declines with age. Cost-effective diabetes management may be organized by primary care clinicians or by case managers working closely with either primary care or subspecialty physicians. Each delivery model has unique advantages and limitations, and there are insufficient data to compare the cost effectiveness of diabetes care across these organizational settings. Improving or enhancing a current model may require substantial investment. However, the resulting changes in the delivery of care may extend the benefits of improved management to other chronic diseases and to preventive care.
There is evidence that patient activation, physician behavior change, and care system improvements may improve care, but the cost effectiveness of these strategies is incompletely understood at present. Selection of clinical goals for improvement is likely to have a major impact on cost effectiveness, with maximal return on investment for blood pressure control, aspirin use, immunizations, and smoking cessation. Effective diabetes care can be delivered across a wide range of care settings, including primary care clinics. The organizational characteristics of clinics and use of tools such as patient registries, guidelines, visit planning and active outreach to patients improve care, but returns on investment with regards to these specific strategies awaits further research.
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