The Evaluation of the Effectiveness of Austrians Disease Management Program in Patients with Type 2 Diabetes Mellitus - A Population-Based Retrospective Cohort Study.

Regina Riedl,Andrea Berghold,Martin Robausch,Gianpaolo Reboldi

doi:10.1371/journal.pone.0161429

Abstract

AimTo evaluate the effectiveness of the Austrian Disease Management Program (DMP) ‘Therapie aktiv—Diabetes im Griff’ for patients with type 2 diabetes mellitus concerning patient-relevant outcomes (mortality, myocardial infarction and stroke) and costs.MethodsBased on routine health insurance data, we conducted a population-based retrospective cohort study using a propensity score (PS) matched control group design. The DMP-group consists of participants enrolled in the program during 2008 and 2009 (n = 7181). Out of 208.532 patients with no participation in the DMP up to 2013, PS-matched controls were selected with a matching ratio 1:3. In the PS-model, patient’s characteristics, form of antidiabetic drug therapy, several prescriptions, the number of hospital admissions and days, main discharge diagnoses and costs at baseline were included.ResultsOver a follow-up period of four years, we observed a significantly lower mortality rate in the DMP-group (9.4%) in comparison with the control group (15.9%, p<0.001). The cumulative number of hospital days and mean annual hospital costs were lower for DMP-participants resulting in significantly lower mean annual total costs, amounting to € 8226.80 per patient in the DMP-group and € 9231.10 in the control group respectively (p<0.001).ConclusionsThe evaluation shows a survival benefit and an average reduction of costs for participants in the DMP compared with the control-group. Despite we took great effort to ensure comparable groups, we cannot entirely rule out an influence by residual and unmeasured confounding due to the observational study design and the use of routine data. However, the results indicate that the disease management program implemented in Austria improves quality of care for patients with type 2 diabetes mellitus.

Highlights

In 2014, about 387 million people worldwide, or 8.3% of the adult population aged 20–79 years, are estimated to have diabetes with increasing incidence [1]
The cumulative number of hospital days and mean annual hospital costs were lower for Disease Management Program (DMP)-participants resulting in significantly lower mean annual total costs, amounting to € 8226.80 per patient in the DMP-group and € 9231.10 in the control group respectively (p
The evaluation shows a survival benefit and an average reduction of costs for participants in the DMP compared with the control-group

Summary

Introduction

In 2014, about 387 million people worldwide, or 8.3% of the adult population aged 20–79 years, are estimated to have diabetes with increasing incidence [1]. Diabetes mellitus is associated with serious long-term complications such as cardiovascular disease, blindness, kidney failure, and amputation of the lower extremities, resulting in increased use of medical services, lower quality of life and reduced life expectancy [3]. In Germany, for example, primary-care based DMPs were implemented nationwide in 2002, including a DMP for type 2 diabetes mellitus [7]. In Austria, the DMP called “Therapie aktiv—Diabetes im Griff” (http://www.therapie-aktiv.at) has the objective to organize long term and high-quality care for patients with type 2 diabetes mellitus. The implementation of this program started in 2007 across most regions of Austria. About 45.000 diabetic patients are included in the program

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Discussion

Conclusion