Resumen de Cost-Effectiveness of the Diabetes Care Protocol, a Multifaceted Computerized Decision Support Diabetes Management Intervention That Reduces Cardiovascular Risk

Frits G. W. Cleveringa, Paco M.J. Welsing, Maureen van-den-Donk, Kees J. Gorter, Louis W. Niessen, Guy E. H. M. Rutten, William K. Redekop

• The Diabetes Care Protocol (DCP), a multifaceted computerized decision support diabetes management intervention, reduces cardiovascular risk of type 2 diabetic patients. We performed a cost-effectiveness analysis of DCP from a Dutch health care perspective. A cluster randomized trial provided data of DCP versus usual care. The 1-year follow-up patient data were extrapolated using a modified Dutch microsimulation diabetes model, computing individual lifetime health-related costs, and health effects. Incremental costs and effectiveness (quality-adjusted life-years [QALYs]) were estimated using multivariate generalized estimating equations to correct for practice-level clustering and confounding. Incremental cost-effectiveness ratios (ICERs) were calculated and cost-effectiveness acceptability curves were created. Stroke costs were calculated separately. Subgroup analyses examined patients with and without cardiovascular disease (CVD+ or CVD-patients, respectively). Excluding stroke, DCP patients lived longer (0.14 life-years, P = NS), experienced more QALYs (0.037, P = NS), and incurred higher total costs (euro1,415, P = NS), resulting in an ICER of euro38,243 per QALY gained. The likelihood of cost-effectiveness given a willingness-to-pay threshold of euro20,000 per QALY gained is 30%. DCP had a more favorable effect on CVD+ patients (ICER = euro14,814) than for CVD- patients (ICER = euro121,285). Coronary heart disease costs were reduced (euro - 587, P < 0.05). 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 type 2 diabetic patients with a history of CVD.