CAN THE FRENCH GATEKEEPING SYSTEM BE COST-EFFECTIVE FOR PATIENTS WITH CHRONIC RESPIRATORY DISORDER?

OBJECTIVES: To estimate the cost-effectiveness impact of the French gatekeeping system on chronic patient treated with inhaled corticosteroids (ICS). The study question is: Can an incentive economic system as the French gatekeeping (“coordinated care pathway”-CCP, August 2004 French Health Insurance reform) have a significant cost-effectiveness impact, from the Health care system perspective. METHODS: A retrospective Health insurance database comparative study was performed. A total of 290 patients in each group were included (e.g. the totality of the non-gatekeeping group available in the database), men and women, from 16 to 50 years old, treated with ICS over a minima period of three consecutive months. The propensity score method (PS) was used in order to reduce selection bias from 12 covariates and a semi-Markovian decision model was performed for comparing costs and effectiveness results between treated group and baseline group, based on these matched individuals. RESULTS: The semi-Markovian model, based on these groups matched, estimates on one-year horizon a 10,000 bootstrap incremental cost-effectiveness ratio (ICER) equal to €33,579 (CI95%: [€33,197 ; €33,960]) per QALY gained. This result is a relevant decisional criterion which is lower than the thresholds (1 to 3 GDP per capita) recommended by the World Health Organization ($200023,927 to $200071,781 for the European Economic Community, region A). CONCLUSIONS: This retrospective study on annual observational data has shown that the French gatekeeping system is cost-effective in the management of patients with chronic respiratory disorder, from the health care system perspective.