A cost-effectiveness analysis of a telephone-linked care intervention for individuals with Type 2 diabetes

• Published in: Diabetes research and clinical practice Vol. 104; no. 1; pp. 103 - 111
• Main Authors: Gordon, L.G, Bird, D, Oldenburg, B, Friedman, R.H, Russell, A.W, Scuffham, P.A
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.04.2014
• Subjects: Adolescent; Adult; Aged; Blood Glucose - metabolism; Cost-Benefit Analysis; Cost-effectiveness analysis; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - therapy; Endocrinology & Metabolism; Female; Follow-Up Studies; Glycated Hemoglobin A - metabolism; Health Care Costs; Humans; Male; Middle Aged; Tele-health; Telemedicine - economics; Telephone; Type 2 diabetes; Young Adult; Type 2 diabetes; Tele-health; Cost-effectiveness analysis
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2013.12.032

Abstract Aim To assess the cost-effectiveness of an automated telephone-linked care intervention, Australian TLC Diabetes, delivered over 6 months to patients with established Type 2 diabetes mellitus and high glycated haemoglobin level, compared to usual care. Methods A Markov model was designed to synthesize data from a randomized controlled trial of TLC Diabetes ( n = 120) and other published evidence. The 5-year model consisted of three health states related to glycaemic control: ‘sub-optimal’ HbA1c ≥58 mmol/mol (7.5%); ‘average’ ≥48–57 mmol/mol (6.5–7.4%) and ‘optimal’ <48 mmol/mol (6.5%) and a fourth state ‘all-cause death’. Key outcomes of the model include discounted health system costs and quality-adjusted life years (QALYS) using SF-6D utility weights. Univariate and probabilistic sensitivity analyses were undertaken. Results Annual medication costs for the intervention group were lower than usual care [Intervention: £1076 (95%CI: £947, £1206) versus usual care £1271 (95%CI: £1115, £1428) p = 0.052]. The estimated mean cost for intervention group participants over five years, including the intervention cost, was £17,152 versus £17,835 for the usual care group. The corresponding mean QALYs were 3.381 (SD 0.40) for the intervention group and 3.377 (SD 0.41) for the usual care group. Results were sensitive to the model duration, utility values and medication costs. Conclusion The Australian TLC Diabetes intervention was a low-cost investment for individuals with established diabetes and may result in medication cost-savings to the health system. Although QALYs were similar between groups, other benefits arising from the intervention should also be considered when determining the overall value of this strategy.