Cost-Effectiveness of Disease Management Programs for Cardiovascular Risk and COPD in The Netherlands

Value Health. 2015 Dec;18(8):977-86. doi: 10.1016/j.jval.2015.07.007. Epub 2015 Sep 16.

Abstract

Background: Disease management programs (DMPs) for cardiovascular risk (CVR) and chronic obstructive pulmonary disease (COPD) are increasingly implemented in The Netherlands to improve care and patient's health behavior.

Objective: The aim of this study was to provide evidence about the (cost-) effectiveness of Dutch DMPs as implemented in daily practice.

Methods: We compared the physical activity, smoking status, quality-adjusted life-years, and yearly costs per patient between the most and the least comprehensive DMPs in four disease categories: primary CVR prevention, secondary CVR prevention, both types of CVR prevention, and COPD (N = 1034). Propensity score matching increased comparability between DMPs. A 2-year cost-utility analysis was performed from the health care and societal perspectives. Sensitivity analysis was performed to estimate the impact of DMP development and implementation costs on cost-effectiveness.

Results: Patients in the most comprehensive DMPs increased their physical activity more (except for primary CVR prevention) and had higher smoking cessation rates. The incremental QALYs ranged from -0.032 to 0.038 across all diseases. From a societal perspective, the most comprehensive DMPs decreased costs in primary CVR prevention (certainty 57%), secondary CVR prevention (certainty 88%), and both types of CVR prevention (certainty 98%). Moreover, the implementation of comprehensive DMPs led to QALY gains in secondary CVR prevention (certainty 92%) and COPD (certainty 69%).

Conclusions: The most comprehensive DMPs for CVR and COPD have the potential to be cost saving, effective, or cost-effective compared with the least comprehensive DMPs. The challenge for Dutch stakeholders is to find the optimal mixture of interventions that is most suited for each target group.

Keywords: COPD; cardiovascular disease; costs; effectiveness; integrated care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism
  • Aged
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Cost-Benefit Analysis
  • Disease Management*
  • Exercise
  • Female
  • Health Services / economics
  • Health Services / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Models, Econometric
  • Netherlands / epidemiology
  • Preventive Health Services / economics*
  • Preventive Health Services / methods*
  • Primary Health Care / organization & administration
  • Propensity Score
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / prevention & control*
  • Quality of Life
  • Quality-Adjusted Life Years
  • Risk Factors
  • Smoking / epidemiology
  • Smoking Cessation / economics
  • Smoking Cessation / methods
  • Travel / economics