Early Enrollment in Diabetes Pay-for-Performance Program Reduced Loss of Life Expectancy in Newly-Diagnosed Patients with Type 2 Diabetes Mellitus.

Abstract

Background: Diabetes is associated with reduced lifespan. To explore pay-for-performance (P4P) program and life expectancy (LE), we investigated the impact of interval between diabetes diagnosis and enrollment in P4P program on loss-of-LE among patients with diabetes in Taiwan.

Methods: From diabetes mellitus health database, which collected all newly-diagnosed patients with diabetes by calendar year, we selected patients, aged 40 to 64, with 503,662 in P4P group and 450,071 in non-P4P group, respectively, from 2004 to 2015, and followed them until the end of 2018 using Kaplan-Meier survival analysis. We simulated age-, gender-, and calendar yearmatched referents for each group through Monte Carlo method from Taiwan's vital statistics. We constructed a restricted cubic spline model on logit-transformed relative survival between each group and its corresponding matched referents, and applied a rolling-over algorithm month-by-month to extrapolate the survival function of each index group to lifetime to estimate the LE, which was subtracted from that of matched referents to obtain the loss-of-LE.

Results: We found stratified analysis by interval showed that the earlier the enrollment, the lower the loss-of-LE, namely, 0.06±0.72 years for interval <1 year, 0.05±0.59 years for interval 1-4 years, 10.01±0.11 years for interval 5-9 years, and 12.77±0.14 years for interval 10-15 years, respectively (P<0.001), compared with 2.60±0.14 years for non-P4P group.

Conclusion: Early enrollment in the P4P program was associated with reduced loss-of-LE, indicating P4P might gain life if implemented early after diabetes diagnosis.