A model-based economic evaluation of improved primary care management of patients with type 2 diabetes in Australia

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dc.contributor.authorHajiali Afzali, H.
dc.contributor.authorGray, J.
dc.contributor.authorBeilby, J.
dc.contributor.authorHolton, C.
dc.contributor.authorKarnon, J.
dc.date.issued2013
dc.description.abstract<h4>Background</h4>There are few studies investigating the economic value of the Australian practice nurse workforce on the management of chronic conditions. This is particularly important in Australia, where the government needs evidence to inform decisions on whether to maintain or redirect current financial incentives that encourage practices to recruit practice nurses.<h4>Objective</h4>The objective of this study was to estimate the lifetime costs and quality-adjusted life-years (QALYs) associated with two models of practice nurse involvement in clinical-based activities (high and low level) in the management of type 2 diabetes within the primary care setting.<h4>Methods</h4>A previously validated state transition model (the United Kingdom Prospective Diabetes Study Outcomes Model) was adapted, which uses baseline prognostic factors (e.g. gender, haemoglobin A1c [HbA1c]) to predict the risk of occurrence of diabetes-related complications (e.g. stroke). The model was populated by data from Australian and UK observational studies. Costs and utility values associated with complications were summed over patients' lifetimes to estimate costs and QALY gains from the perspective of the health care system. All costs were expressed in 2011 Australian dollars (AU$). The base-case analysis assumed a 40-year time horizon with an annual discount rate of 5 %.<h4>Results</h4>Relative to low-level involvement of practice nurses in the provision of clinical-based activities, the high-level model was associated with lower mean lifetime costs of management of complications (-AU$8,738; 95 % confidence interval [CI] -AU$12,522 to -AU$4,954), and a greater average gain in QALYs (0.3; 95 % CI 0.2-0.4). A range of sensitivity analyses were performed, in which the high-level model was dominant in all cases.<h4>Conclusion</h4>Our results suggest that the high-level model is a dominant management strategy over the low-level model in all modelled scenarios. These findings indicate the need for effective primary care-based incentives to encourage general practices not only to employ practice nurses, but to better integrate them into the provision of clinical services.
dc.description.statementofresponsibilityHossein Haji Ali Afzali, Jodi Gray, Justin Beilby, Christine Holton, Jonathan Karnon
dc.identifier.citationApplied Health Economics and Health Policy, 2013; 11(6):661-670
dc.identifier.doi10.1007/s40258-013-0062-9
dc.identifier.issn1175-5652
dc.identifier.issn1179-1896
dc.identifier.orcidHajiali Afzali, H. [0000-0002-0198-8394]
dc.identifier.orcidGray, J. [0000-0002-1119-7078]
dc.identifier.orcidKarnon, J. [0000-0003-3220-2099]
dc.identifier.urihttp://hdl.handle.net/2440/82231
dc.language.isoen
dc.publisherAdis International Ltd.
dc.relation.grantARC
dc.rights© Springer International Publishing Switzerland 2013
dc.source.urihttps://doi.org/10.1007/s40258-013-0062-9
dc.subjectHumans
dc.subjectDiabetes Mellitus, Type 2
dc.subjectDiabetes Complications
dc.subjectPrognosis
dc.subjectTreatment Outcome
dc.subjectModels, Economic
dc.subjectQuality-Adjusted Life Years
dc.subjectModels, Nursing
dc.subjectMiddle Aged
dc.subjectCost-Benefit Analysis
dc.subjectHealth Care Costs
dc.subjectPrimary Health Care
dc.subjectAustralia
dc.subjectFemale
dc.subjectMale
dc.subjectPropensity Score
dc.titleA model-based economic evaluation of improved primary care management of patients with type 2 diabetes in Australia
dc.typeJournal article
pubs.publication-statusPublished

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