Cost implication of team-based structured versus usual care for type 2 diabetic patients with chronic renal disease.

Key Messages 1. Type 2 diabetic patients with chronic kidney disease receiving structured care (SC) by a diabetologist-nurse team or usual care (UC) had a similar incidence of end-stage renal disease (24 of 104 vs 24 of 101) after intervention for 2 years. 2. Patients receiving SC were three times more likely to attain three or more predefined treatment targets than those receiving UC (63 of 104 vs 28 of 101). 3. Of 91 patients who attained three or more treatment targets, 14 died or developed end-stage renal disease, compared to 34 of the remaining 114 patients. This amounted to a 60% risk reduction in favour of SC. 4. The total number of hospital days was 933 in the SC group and 1169 in the UC group, with a cost difference of HK$631 300 over a 2-year period. 5. Using trained nurses to review these patients under medical supervision which incurred an extra cost of HK$476 736 in the SC model was cost-saving in a public health care setting. 6. Assuming all eight extra out-patient visits were medical consultations during the 2-year period, an extra cost of HK$322 172 would have been incurred for the whole group. 7. Using a traditional medical model, additional yearly cost of HK$2557 to 40 272 would be required for a patient to attain multiple treatment targets or save one major clinical event if all review visits were by doctors.