Cost-effectiveness of a quality improvement collaborative focusing on patients with diabetes

Med Care. 2010 Oct;48(10):884-91. doi: 10.1097/MLR.0b013e3181eb318f.


Objective: To investigate the lifelong health effects, costs, and cost-effectiveness of a quality improvement collaborative focusing on improving diabetes management in an integrated care setting.

Study design and methods: Economic evaluation from a healthcare perspective with lifetime horizon alongside a nonrandomized, controlled, before-after study in the Netherlands. Analyses were based on 1861 diabetes patients in 6 intervention and 9 control regions, representing 37 general practices and 13 out-patient clinics. Change in the United Kingdom Prospective Diabetes Study score, remaining lifetime, and costs per quality-adjusted life year gained were calculated. Probabilistic life tables were constructed using the United Kingdom Prospective Diabetes Study risk engine, a validated diabetes model, and nonparametric bootstrapping of individual patient data.

Results: Annual United Kingdom Prospective Diabetes Study risk scores reduced for cardiovascular events (hazard ratio: 0.83 and 0.98) and cardiovascular mortality (hazard ratio: 0.78 and 0.88) for men and women, respectively. Life expectancy improved by 0.97 and 0.76 years for men and women, and quality-adjusted life years by 0.44 and 0.37, respectively. Higher life expectancy in the intervention group increased lifelong costs by &OV0556;860 for men and &OV0556;645 for women. Initial program costs were about &OV0556;22 per patient. The incremental costs per quality-adjusted life year were &OV0556;1937 for men and &OV0556;1751 for women compared with usual care costs. There is a probability >95% that the collaborative is cost-effective, using a threshold of &OV0556;20,000 per quality-adjusted life year.

Conclusion: Optimizing integrated and patient-centered diabetes care through a quality-improvement collaborative is cost-effective compared with usual care.

Trial registration: NCT00160017.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care Facilities / economics
  • Ambulatory Care Facilities / organization & administration*
  • Angina Pectoris / economics
  • Angina Pectoris / prevention & control
  • Cooperative Behavior
  • Cost-Benefit Analysis
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / economics*
  • Diabetes Mellitus, Type 2 / prevention & control
  • Diabetes Mellitus, Type 2 / therapy*
  • Diabetic Angiopathies / economics
  • Diabetic Angiopathies / prevention & control
  • Diabetic Nephropathies / economics
  • Diabetic Nephropathies / prevention & control
  • Female
  • Humans
  • Kidney Failure, Chronic / economics
  • Kidney Failure, Chronic / prevention & control
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Patient-Centered Care / economics
  • Patient-Centered Care / organization & administration*
  • Quality Assurance, Health Care / economics
  • Quality Assurance, Health Care / organization & administration*
  • Quality of Life
  • Quality-Adjusted Life Years

Associated data