Assessment of Costs of Obtaining Improved Diabetes Outcomes by Efficient and Inefficient Patients
- Presenter:
Chair: F. Reed Johnson; Discussant: TBA Mon June 5, 2006 17:15-18:45 Room 225
Rationale: Treatment and management of chronic illness is an increasing concern as both costs of medical care rise and the number of persons with chronic illnesses grows. A better understanding is needed of the effectiveness and costs of interventions designed to improve patient control over chronic conditions.
Objectives: This study focuses on a cohort of patients (N=558) with type 2 diabetes in 1997-2004. This cohort received an intervention, UNITED Planned Care (UPC), that appeared to equalize treatment outcomes between groups of patients who were highly efficient (N=95) in managing their care and an inefficient group (N=95) who were poor managers of care in 1997 and 2004. The objective of this study is to measure the provider costs of equalizing the performance of the two groups on three outcomes: HbgA1c, LDL, and SBP.
Methodology: Provider costs of care to adult type 2 diabetes patients (N=190) enrolled in UPC will be measured for 1997-2004. Costs of the highly efficient and inefficient groups of patients will be compared. Data to measure utilization and costs are in the UPC database and the Olmsted County Healthcare Expenditure and Utilization Database (OCHEUD).
The provider costs to be measured are a) the costs of services and resources from UPC utilized by patients and b) the total costs of all health care and medical services utilized by patients, including hospitalization, over the seven years. Differences in costs between the two groups will be obtained and reported in both nominal and 2004 dollars.
Data Envelopment Analysis (DEA) has been used to assign efficiency classifications to UPC patients. These results have been reported at the Karolinska Institute and other venues. 95 patients on the efficiency frontier were considered very efficient managers of care, while 95 patients farthest from the frontier were considered inefficient managers of care. Input variables in the analysis included BMI, frequency of self glucose monitoring, the use of diabetes medications, statins, cardiovascular medications. Output variables included: HgbA1c, SBP, LDL, cardiovascular events; myocardial infarction, stroke, vascular procedure.
Results: Highly efficient patients had uniformly superior diabetes outcomes in 1997 compared to inefficient patients. The OR (95%CI) were 0.52 (0.42, 0.63) HgbA1c, 0.98 (0.97, 0.99) LDL, and 0.94 (0.92, 0.96) SBP. In 2004, statistical differences in diabetes outcomes between the groups had disappeared: 0.91 (0.76, 1.09) HgbA1c, 0.99 (0.98, 1.00) LDL, and 0.98 (0.97, 1.00) SBP. Patients in the low efficiency DEA group, however, remained in that group.
Conclusions: The apparent lack of efficiency improvements while outcome differences decreased suggests that the better performance of inefficient patients on the outcome measures may be due to increased inputs. We hypothesize that our study will show that a) improvements in outcomes were obtained at modest UPC cost differences but b) total health care costs were substantially higher in the inefficient group while narrowing over the seven years.
