Long-Term Cost-utility Analysis of a Multidisciplinary Primary Care Diabetes Management Program in Ontario

OBJECTIVESTo estimate the cost-effectiveness of a multidisciplinary diabetes management program using the Ontario Diabetes Economic Model (ODEM).METHODSUsing an Ontario-specific United Kingdom Prospective Diabetes Study Outcomes Model, changes in risk factors (e.g. glycosylated hemoglobin) were used to predict event rates for diabetes-related complications, costs and expected quality-adjusted life years (QALYs). Incremental costeffectiveness ratios were calculated based on the cost of the program, projected cost and effectiveness over a lifetime. The base case assumed a 1-year treatment effect, 3% discount rate and 40-year time horizon.RESULTSThe ODEM estimated that improvements in risk factors prevented 16.2/1000 deaths and 15.5/1000 myocardial infarctions, and led to a 50% relative risk reduction in first amputations.The lifetime incremental cost per QALY gained in the base case was $5992.CONCLUSIONShort-term outcomes were improved, translating into avoidance of downstream complications; thus, the increased costs of program implementation were partly offset. Overall, the program represents a cost-effective method for managing type 2 diabetes.