Economic evaluation of a diabetes disease management programme with a central role for the diabetes nurse specialist

Abstract

Background: In the region of Maastricht, The Netherlands, a disease management programme (DMP) for patients with diabetes mellitus was implemented. The programme aims to improve quality of care within existing budgets. To achieve this, diabetes nurse specialists (DNSs) were given a central role within a multidisciplinary team of care providers. This study describes the cost-effectiveness of this approach. - Aim: To measure the incremental cost-effectiveness of a diabetes DMP, with a central role for the diabetes nurse specialist, in comparison to usual diabetes care. - Methods: Within the DMP, patients with low, medium and high complexities of care are cared for by general practitioners, DNSs and endocrinologists, respectively. The DNSs independently treat patients assigned to them and pay special attention to extensive self-management education. A quasi-experimental trial with two-year follow-up (n = 473) was undertaken to measure the cost-effectiveness of the DMP compared with usual care. - Results: A total of 23% of patients were assigned to the GP, 66% to the DNS and 10% to the endocrinologist. Statistical significant improvements in glycaemic control, health-related quality of life, compliance and most aspects of self-care behaviour were found. No statistically significant changes were found concerning total costs of care. All improvements were greatest in patients assigned to DNS. - Conclusion: A DMP in which DNSs play a central role is associated with improved quality of care within existing budgets. Patients assigned to DNS benefit most, indicating that the central role of DNS in the diabetes DMP is one of its critical success factors.