Abstract
Objective: We evaluated the cost-effectiveness of the point-of-care A1c (POC-A1c) test device vs. the traditional laboratory dosage in a primary care setting for people living with type 2 diabetes. Materials and Methods: The Markov model with a 10-year time horizon was based on data from the HealthRise project, in which a group of interventions was implemented to improve diabetes and hypertension control in the primary care network of the urban area of a Brazilian municipality. A POC-A1c device was provided to be used directly in a primary care unit, and for a period of 18 months, 288 patients were included in the point-of-care group, and 1,102 were included in the comparison group. Sensitivity analysis was performed via Monte Carlo simulation and tornado diagram. Results: The results indicated that the POC-A1c device used in the primary care unit was a cost-effective alternative, which improved access to A1c tests and resulted in an increased rate of early control of blood glucose. In the 10-year period, POC-A1c group presented a mean cost of US$10,503.48 per patient and an effectiveness of 0.35 vs. US$9,992.35 and 0.09 for the traditional laboratory test, respectively. The incremental cost was US$511.13 and the incremental effectiveness was 0.26, resulting in an incremental cost-effectiveness ratio of 1,947.10. In Monte Carlo simulation, costs and effectiveness ranged between $9,663.20–$10,683.53 and 0.33–0.37 for POC-A1c test group, and $9,288.28–$10,413.99 and 0.08–0.10 for traditional laboratory test group, at 2.5 and 97.5 percentiles. The costs for nephropathy, retinopathy, and cardiovascular disease and the probability of being hospitalized due to diabetes presented the greatest impact on the model’s result. Conclusion: This study showed that using POC-A1c devices in primary care settings is a cost-effective alternative for monitoring glycated hemoglobin A1c as a marker of blood glucose control in people living with type 2 diabetes. According to our model, the use of POC-A1c device in a healthcare unit increased the early control of type 2 diabetes and, consequently, reduced the costs of diabetes-related outcomes, in comparison with a centralized laboratory test.
Highlights
People living with diabetes mellitus (DM) have an increased risk of disabilities and early death due to macro and microvascular complications resulting from poor glycemic control (Camargos et al, 2018)
We developed a Markov-based economic model to evaluate the cost-effectiveness of POC-A1c for the municipal government perspective, for routine monitoring of people living with type 2 diabetes
This study evaluated data from people living with DM who were seen at the 16 primary care units (PCU) in the urban zone of Vitória da Conquista
Summary
People living with diabetes mellitus (DM) have an increased risk of disabilities and early death due to macro and microvascular complications resulting from poor glycemic control (Camargos et al, 2018). The A1c test allows the healthcare team to determine which individuals need to have their treatment reviewed, with the aim of avoiding both overtreatment and the worsening of their clinical presentation due to the lack of glycemic control (Hirst et al, 2017). A1c tests predict which individuals have a higher risk of complications due to their target status (Camargos et al, 2018). There are several obstacles that prevent people living with DM from having A1c tests regularly. People with low-income and rural populations face this difficulty (Zheng et al, 2018)
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