Abstract
BackgroundTo discriminatively evaluate the cost-saving effects of a disease management program for diabetic nephropathy patients through care process rectification and, subsequently, improved health outcomes.MethodsThis study links public medical insurance claims data to the health records of a disease management program for diabetic nephropathy patients. To account for selection bias caused by the non-randomized allocation of the disease management program for diabetes patients, we adopted a fixed-effect model of panel data analysis. To discriminatively evaluate the cost-saving effects of the disease management program for diabetic nephropathy patients through care process rectification and, subsequently, improved health outcomes, we expanded the difference-in-differences analysis from the traditional two-period model to a three-period model, comprising the before-intervention, during-intervention, and after-intervention periods. Data were extracted from municipal public insurers in Kure, Japan.ResultsThe cost-reduction effect in terms of treatment costs from the before-intervention period to the during-intervention period (the rectification effect) was 4.02%, and the cost-saving effect from the during-intervention period to the after-intervention period (the health improvement effect) was 2.95%.ConclusionsA disease management program for diabetes patients organized by local public insurers in Japan reduced costs both by amending treatment processes and by subsequently improving the prognosis of the disease.
Highlights
To discriminatively evaluate the cost-saving effects of a disease management program for diabetic nephropathy patients through care process rectification and, subsequently, improved health outcomes
We focused on a Disease management for diabetes (DMD) program organized by local public health insurers that has already been shown to be clinically effective for preventing diabetic nephropathy
The rectification effect accounted for a 4.02% reduction in dialysis costs from the before-intervention period to the during-intervention period, and the health improvement effect accounted for a 2.95% reduction in dialysis costs from the duringintervention period to the after-intervention period
Summary
To discriminatively evaluate the cost-saving effects of a disease management program for diabetic nephropathy patients through care process rectification and, subsequently, improved health outcomes. Disease management for diabetes (DMD) has long been thought to be effective in preventing disease-related complications and to Kawaguchi et al BMC Health Services Research (2020) 20:403 in Germany lacked a comparable control group and were vulnerable to selection bias. These studies did not report the cost-saving impact of the German DMD program. Several econometric studies have been conducted to empirically evaluate the impact of DMD programs on health outcomes and cost savings. Kranker [12] employed the difference-indifferences (DD) technique with fixed-effects estimators, finding that DMD interventions for those at higher risk of disease-related complications reduced medical expenditures for diabetes treatment by 8.3% in the Georgia Medicaid program in the United States
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