Abstract
Pay for performance (P4P) has been used as a strategy to improve quality for patients with chronic illness. Little was known whether care provided to individuals with multiple chronic conditions in a P4P program were cost-effective. This study investigated cost effectiveness of a diabetes P4P program for caring patients with diabetes alone (DM alone) and diabetes with comorbid hypertension and hyperlipidemia (DMHH) from a single payer perspective in Taiwan. Analyzing data using population-based longitudinal databases, we compared costs and effectiveness between P4P and non-P4P diabetes patient groups in two cohorts. Propensity score matching (PSM) was used to match comparable control groups for intervention groups. Outcomes included life-years, quality-adjusted life-years (QALYs), program intervention costs, cost-savings and incremental cost-effectiveness ratios (ICERs). QALYs for P4P patients and non-P4P patients were 2.80 and 2.71 for the DM alone cohort and 2.74 and 2.66 for the DMHH patient cohort. The average incremental intervention costs per QALYs was TWD$167,251 in the DM alone cohort and TWD$145,474 in the DMHH cohort. The average incremental all-cause medical costs saved by the P4P program per QALYs were TWD$434,815 in DM alone cohort and TWD$506,199 in the DMHH cohort. The findings indicated that the P4P program for both cohorts were cost-effective and the resulting return on investment (ROI) was 2.60:1 in the DM alone cohort and 3.48:1 in the DMHH cohort. We conclude that the diabetes P4P program in both cohorts enabled the long-term cost-effective use of resources and cost-savings, especially for patients with multiple comorbid conditions.
Highlights
The increase in patients with multiple chronic conditions (MCCs) poses a great challenge to many countries’ healthcare systems, especially those with aging populations [1, 2]
The purpose of this study is to investigate whether a diabetes P4P program allowed for a cost-effective use of resources and to what extent their cost effectiveness differed for caring patients with Diabetes alone and multiple comorbid conditions from a single payer perspective in Taiwan
Using the P4P database, we identified newly enrolled P4P patients as study P4P cohorts during the patient identification period and defined the date for each P4P patient as the date that they were first enrolled in the P4P program as index date
Summary
The increase in patients with multiple chronic conditions (MCCs) poses a great challenge to many countries’ healthcare systems, especially those with aging populations [1, 2]. Hypertension and hyperlipidemia are two often uncontrolled modifiable cardiovascular disease (CVD) risk factors in patients with type 2 diabetes [6]. Taiwan has seen a more than a two-fold increase in the number of cases of diabetes with comorbid hypertension and hyperlipidemia from 10.47% in 2000 to 25.65% in 2009 [8]. Such patients have a lower quality of life, higher utilization of health care services and related costs, and significantly higher risk of CVD-related morbidity and mortality [9,10,11]. To provide patient-centered care for those multi-morbid diabetic patients became important priority in many countries [2]
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