| Cost-effectiveness of a quality improvement collaborative focusing on patients with diabetes. | |
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MedLine Citation:
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PMID: 20808258 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Loes M T Schouten; Louis W Niessen; Jeroen W A M van de Pas; Richard P T M Grol; Marlies E J L Hulscher |
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Publication Detail:
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Type: Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Medical care Volume: 48 ISSN: 1537-1948 ISO Abbreviation: Med Care Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-22 Completed Date: 2010-10-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0230027 Medline TA: Med Care Country: United States |
Other Details:
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Languages: eng Pagination: 884-91 Citation Subset: IM |
Affiliation:
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Dutch Institute for Healthcare Improvement, Utrecht, The Netherlands. l.schouten@cbo.nl |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00160017 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Ambulatory Care Facilities / economics, organization & administration* Angina Pectoris / economics, prevention & control Cooperative Behavior Cost-Benefit Analysis Diabetes Mellitus, Type 2 / complications, economics*, prevention & control, therapy* Diabetic Angiopathies / economics, prevention & control Diabetic Nephropathies / economics, prevention & control Female Humans Kidney Failure, Chronic / economics, prevention & control Male Middle Aged Netherlands / epidemiology Patient-Centered Care / economics, organization & administration* Quality Assurance, Health Care / economics, organization & administration* Quality of Life Quality-Adjusted Life Years |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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