OBJECTIVES : The cluster-randomized prospective PDM-ProValue study examined the effectiveness of a structured, IT-supported, integrated, and personalised outpatient care process (iPDM) in 907 insulin-treated people with type 2 diabetes from 101 medical practices. It published among other outcomes an improved primary outcome of -0.5% HbA1c in the intent-to-treat cohort. A Markov model-based cost-effectiveness study was performed with the PDM-ProValue study effects.

METHODS : Validated and open source published models of the PROSIT Disease Modelling Community were inputted with the PDM-ProValue cohort (age 64.7y, diabetes duration 14.3y, 10.0% previous myocardial infarctions) and simulated over the remaining lifetime.

The evaluation compared macrovascular events, life expectancy and quality-adjusted life years (QALYs) of four comparators: No HbA1c-treatment effect (Baseline), the intervention group of PDM-ProValue (iPDM), the PDM-ProValue control group (Control), the PDM-ProValue cohort without any pre-existing conditions (NoLC).

Total direct treatment cost (TDC) data of the German CoDiM trial was inflated to the reference year 2016. Thus, a Statutory Healthcare System perspective without program costs was adopted. Discount rates of 0%, 3%, and 5% were applied according to IQWIG requirements.

RESULTS : The models estimated the TDC of iPDM at 155,401€ per patient (Control=155,457€, Baseline=155,058€, NoLC=134,429€). Loss of life expectancy was 6.39y (Baseline vs life table): iPDM gains 0.52y life expectancy vs Baseline (Control=+0.04y, NoLC=-1.75y). iPDM avoids 1.61% further first heart attacks (Control=0.63%, NoLC=-3.23%). ICER of iPDM vs Control was -2,212.86€ per life year gained (=-2,839.92€ per QALY gained). ICER of iPDM vs Baseline was +811.39€ per life year gained (=+1,194.64€ per QALY gained). Cost savings were highest in the first year, discounting did not change the picture.

CONCLUSIONS : iPDM reduces mortality and heart attacks and improves the quality of life. iPDM offers cost savings in the beginning but the higher life expectancy consumes earlier monetary benefits. The negative ICERs of iPDM vs Control indicate a good value for the money.