Abstract
BackgroundDiabetes mellitus contributes substantially to the non-communicable disease burden in South Africa. The proposed National Health Insurance system provides an opportunity to consider the development of a cost-effective capitation model of care for patients with type 2 diabetes. The objective of the study was to determine the potential cost-effectiveness of adapting a private sector diabetes management programme (DMP) to the South African public sector.MethodsCost-effectiveness analysis was undertaken with a public sector model of the DMP as the intervention and a usual practice model as the comparator. Probabilistic modelling was utilized for incremental cost-effectiveness ratio analysis with life years gained selected as the outcome. Secondary data were used to design the model while cost information was obtained from various sources, taking into account public sector billing.ResultsModelling found an incremental cost-effectiveness ratio (ICER) of ZAR 8 356 (USD 1018) per life year gained (LYG) for the DMP against the usual practice model. This fell substantially below the Willingness-to-Pay threshold with bootstrapping analysis. Furthermore, a national implementation of the intervention could potentially result in an estimated cumulative gain of 96 997 years of life (95% CI 71 073 years – 113 994 years).ConclusionsProbabilistic modelling found the capitation intervention to be cost-effective, with an ICER of ZAR 8 356 (USD 1018) per LYG. Piloting the service within the public sector is recommended as an initial step, as this would provide data for more accurate economic evaluation, and would also allow for qualitative analysis of the programme.
Highlights
Diabetes mellitus contributes substantially to the non-communicable disease burden in South Africa
Ersatz, a Results The results as described below in terms of: (1) the costs of the models; (2) the cost consequences related to cardiovascular disease (CVD) risk reduction; (3) the life table modelling and, (4) the incremental cost-effectiveness ratio (ICER) and WTP results
Cost consequences results The 10-year absolute risk reductions of CVDs potentially offered by the capitation intervention were projected by using the UKDPS risk engine (Table 4)
Summary
Diabetes mellitus contributes substantially to the non-communicable disease burden in South Africa. The proposed National Health Insurance system provides an opportunity to consider the development of a cost-effective capitation model of care for patients with type 2 diabetes. The objective of the study was to determine the potential cost-effectiveness of adapting a private sector diabetes management programme (DMP) to the South African public sector. South Africa is undergoing an epidemiological transition characterized by a growing burden of non-communicable diseases [1]. The disease has contributed considerably to mortality - according to Statistics South Africa, diabetes caused 3.3% of the deaths recorded in. The delivery of appropriate care for patients living with diabetes is a major challenge within South Africa’s health system. A risk-adjusted capitation approach was proposed as a possible method of reimbursing accredited providers within the NHI dispensation [4]
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