Cost-Effectiveness of Radar: An Innovative Model to Organize Diabetes Care in First Nations Communities in Canada

OBJECTIVES: RADAR (Reorganizing the Approach to Diabetes through the Application of Registries) is an innovative care model that incorporates a disease registry and electronic health record for local care provision with remote coordination tailored for First Nation (FN) people in Alberta, Canada. RADAR improved outcomes with patients achieving 10% improvement in HbA1c, SBP, and/or LDL cholesterol. This study aimed to evaluate the cost-effectiveness of RADAR compared with existing baseline diabetes care in FNS with type 2 diabetes (T2DM).

METHODS: We used the United Kingdom Prospective Diabetes Study (UKPDS) OM 2 for this CEA. Demographics like age, gender, and clinical parameters height, weight, diabetes duration, LDL, HDL, SBP, HbA1c, and eGFR of RADAR users relative to their baseline status (n=516) were used as input parameters for the model. Other input parameters like cost and utility were taken from literature. Outcome measures included life years (LY’s), quality-adjusted life expectancy (QALE), total costs, and complication rates. The base-case analysis was conducted using a Canadian payer perspective with a 70-year time horizon. Costs and effects were discounted at 3.5% annually.

RESULTS: Discounted life expectancy at baseline was 14.78 (95% CI 14.50,15.25), and after RADAR was 14.66 (95% CI 14.40,15.13). Discounted QALE at baseline was 14.59 (95% CI 14.31,15.06) and after RADAR was 14.46 (95% CI 14.20,14.92). The incremental cost of the intervention was $4546. There was no significant difference in the incidence of IHD, MI, heart failure, stroke, and renal failure over 70 years between the RADAR and non-RADAR users. Routine care alone dominated over RADAR users with an ICER of -$37,833/QALE gained.

CONCLUSIONS: RADAR improved immediate clinical outcomes in the FN population in Canada over 2 years, however, this was associated with an increase in costs. Given the fragmented care for FN people, additional costs to improve outcomes is warranted to ensure equitable healthcare in Canada.