Priyanka Ghule, Ishfaq Rashid, Jasjeet K Minhas-Sandhu, Lynden Crowshoe, Jeffrey A Johnson, Salim Samanani, Cerina Dubois, Carl V Asche, Dean T Eurich
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Abstract
Introduction: The Reorganizing the Approach to Diabetes through the Application of Registries (RADAR) is an innovative care model incorporating a disease registry and electronic health record tailored for First Nations (FN) people in Alberta, Canada. Given its success in improving health outcomes, this study evaluates RADAR's cost-effectiveness compared to standard diabetes care in FN populations with type 2 diabetes (T2DM).
Methods: The United Kingdom Prospective Diabetes Study Outcomes Model 2 was used to project clinical and cost outcomes over 25 years. Demographics and clinical parameters were used as input parameters. Costs (for RADAR and complications) and utility estimates were derived from the literature. Outcome measures included life years, quality-adjusted life years (QALY's), total and complication costs. Base case analysis was conducted for eligible T2DM patients ≥ 18 years using a Canadian payer perspective with a 25-year time horizon. Future costs and effects were discounted at 3% annually.
Results: RADAR clients experienced higher QALYs (12.69 vs. 12.47) than those receiving baseline care. The total cost for RADAR clients (n=516) was $3,971 more per client compared to baseline care. Over the modeled time horizon, the total discounted costs (client management and complications) were higher for RADAR clients than for those receiving baseline care ($16,165 vs. $14,463), yielding an ICER of $8,105 per QALY for RADAR users relative to baseline.
Conclusion: Our analyses showed that RADAR is potentially cost-effective if the willingness to pay a threshold of $50,000 per QALY is considered as per the CADTH guidelines, supporting its value in FN care.
简介：通过登记应用重组糖尿病方法（RADAR）是一种创新的护理模式，结合了疾病登记和电子健康记录，为加拿大阿尔伯塔省的第一民族（FN）量身定制。鉴于RADAR在改善健康结果方面的成功，本研究评估了RADAR与标准糖尿病护理相比在FN人群中2型糖尿病（T2DM）的成本效益。方法：使用英国前瞻性糖尿病研究结果模型2来预测25年的临床和成本结果。人口统计学和临床参数作为输入参数。成本（雷达和并发症）和效用估算来源于文献。结局指标包括生命年、质量调整生命年（QALY’s）、总成本和并发症成本。对符合条件的≥18岁T2DM患者进行基本病例分析，采用加拿大付款人视角，时间跨度为25年。未来的成本和影响按每年3%折现。结果：与接受基线护理的患者相比，RADAR患者的QALYs （12.69 vs 12.47）更高。与基线护理相比，每位RADAR患者（n=516）的总成本增加了3,971美元。在建模的时间范围内，RADAR患者的总折扣成本（客户管理和并发症）高于接受基线护理的患者（16,165美元对14,463美元），相对于基线，RADAR用户每个QALY的ICER为8,105美元。结论：我们的分析表明，如果按照CADTH指南考虑每个QALY支付50,000美元阈值的意愿，RADAR具有潜在的成本效益，支持其在FN护理中的价值。
期刊介绍：
Value in Health contains original research articles for pharmacoeconomics, health economics, and outcomes research (clinical, economic, and patient-reported outcomes/preference-based research), as well as conceptual and health policy articles that provide valuable information for health care decision-makers as well as the research community. As the official journal of ISPOR, Value in Health provides a forum for researchers, as well as health care decision-makers to translate outcomes research into health care decisions.
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