Abstract
Chronic conditions are the leading cause of growing healthcare spending, disability, and death in the U.S. In the wake of national health reform, policy makers and healthcare professionals are becoming increasingly concerned in containing healthcare costs while improving quality of patient care. A basic policy question is whether the Chronic Disease Self-Management Program (CDSMP), a widely distributed evidenced-based self-managed program, can be cost-effective in managing chronic conditions while improving quality of life. Utilizing data from the National Study of CDSMP, the primary objective of the current study is to estimate cost-effectiveness of the CDSMP program among individuals with at least one chronic condition. The second objective is to determine how cost-effectiveness ratios vary by depression status. EuroQol-5D (EQ-5D) was used to measure health-related quality of life (HRQOL) of CDSMP participants, which was then converted to quality-adjusted life years (QALYs) for cost-effectiveness analysis. Participants who completed the CDSMP program experienced higher EQ-5D scores from baseline to 12-month follow-up (increased from 0.736 to 0.755; p < 0.001). The incremental cost-effectiveness ratio (ICER) ranges from $83,285 to $31,285 per QALYs, which can be comparable to the common benchmark of $50,000/QALYs. ICER by baseline depression status indicates that it will cost more per QALYs gained for those diagnosed with depression based on their Patient Health Questionnaire-8 score. However, cautions should be taken while considering this point estimate too literally because the average cost for CDSMP participants was a rough estimate and based on several simplifying assumptions. Identifying cost-effective strategies that can lower the burden of chronic disease among community-dwelling adults is critical for decision makers in allocating limited resources. Policy makers and community organizations can use this information to guide funding decisions and delivery of CDSMP programs for individuals with multiple chronic health conditions.
Highlights
With the rapid aging of the baby boomer cohort, it is estimated that one in five Americans will be 65 years or older by 2030 [1]
As healthcare costs continue to rise for treating chronic diseases, identifying ways to manage the progression of multiple chronic conditions among older adults is critical and time-sensitive [12, 13]
NATIONAL STUDY OF CDSMP AS STUDY BASIS The current study utilized a change in health-related quality of life (HRQOL) measures at three time points to examine the cost-effectiveness of the intervention among middle-aged and older adults enrolled in the National Study of the Chronic Disease Self-Management Program (CDSMP)
Summary
With the rapid aging of the baby boomer cohort, it is estimated that one in five Americans will be 65 years or older by 2030 [1]. HRQOL is a multi-dimensional measure, which is defined as “perceived physical and mental health over time” [9]. It can be considered as a part of a person’s overall quality of life that is determined by his or her health status. In light of the growing prevalence of chronic illness, healthcare burdens, and concerns for promoting population health, service providers and policy makers are pursuing cost-effective ways to design self-management programs that can improve the health and well-being of the population [10, 11]. As healthcare costs continue to rise for treating chronic diseases, identifying ways to manage the progression of multiple chronic conditions among older adults is critical and time-sensitive [12, 13]
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