Cost-Effectiveness Of Disease Management Programs For Cardiovascular Risk And Copd In The Netherlands.

Abstract

Disease management programs (DMPs) for cardiovascular risk (CVR) and chronic obstructive pulmonary disease (COPD) are increasingly implemented in the Netherlands to improve quality of care and patient’s lifestyle. The aim of the study was to provide evidence about the (cost-) effectiveness of Dutch DMPs as implemented in daily practice. We compared the 2-year costs and changes in physical activity, smoking behaviour, and utilities between the most and the least comprehensive DMP in four disease categories: primary CVR-prevention, secondary CVR-prevention, both types of CVR-prevention, and COPD (total n: 1034). Propensity score matching increased comparability between DMPs. A cost-utility analysis was performed from the health care and societal perspective. Sensitivity analysis was performed to estimate the impact of DMP development and implementation costs on the cost-effectiveness. Patients in the most comprehensive DMPs increased physical activity and had higher smoking cessation probabilities after 2 years in most disease categories. From a health care perspective, the incremental costs were positive in primary CVR-prevention (96% certainty), negative in secondary and both types of CVR prevention (93% and 98% certainty) and indifferent in COPD. The incremental QALYs were positive in all categories (certainty range: 64%-80%). The incremental cost-effectiveness ratio’s ranged from €-114,662 to €8,849. The results from the societal perspective and the sensitivity analysis were in the same line. The most comprehensive DMPs for CVR and COPD were cost-effective compared to the least comprehensive DMPs. The challenge for Dutch stakeholders is to find the optimal mixture of interventions.