Cost-effectiveness of protocolized and managed care compared to usual care for patients with type 2 diabetes

Objectives: To compare the cost-effectiveness of two diabetes management models with usual care for type 2 diabetes patients from the societal perspective. Methods: An economic evaluation was performed alongside a clinical trial. In two distinct regions of the Netherlands, two diabetes management models were implemented: managed and protocolized care, with different levels of centralized organizational structures. The clinical outcome measure was risk of a coronary heart disease (CHD) calculated with the UKDPS risk engine. Cost-effectiveness analysis was performed from the societal perspective comparing patients receiving managed (n=313) and protocolized (n=293) care with patients receiving usual diabetes care (n=485) during one year of follow-up. Missing costs and effects data were imputed using multiple imputation. Differences in costs, effects and cost-effectiveness between the diabetes management groups and usual care were analysed using bootstrapping techniques. Results: Differences in changes in CHD risk over 12 months of follow-up between the three groups were statistically insignificant and clinically irrelevant. Compared to usual care, health care costs during the follow-up period were lower in protocolized (-960 (95% CI:-1890 to-100)) and managed care (-1300 (95% CI:-2300 to-570)). Costs from the societal perspective showed the same trend, although not statistically significant. Conclusions: Clinical outcomes did not differ between the different types of care. Lower health care costs were observed in protocolized and managed care compared to usual care, mainly due to substitution of secondary health care use by primary health care use. This suggests that protocolized or managed care result in equal outcomes at lower health care costs.