THE LONGTERM COST EFFECTIVENESS OF THE “COACHING PATIENTS ON ACHIEVING CARDIOVASCULAR HEALTH” (COACH) PROGRAM IN TYPE 2 DIABETES IN TASMANIA

Author(s)

Palmer AJ1, Vale MJ2, Wells CL3, Ski C2, Thompson DR2, Si L4
1Menzies Institute for Medical Research, Hobart, Australia, 2Australian Catholic University, Melbourne, Australia, 3Diabetes Tasmania, Hobart, Australia, 4University of Tasmania, Hobart, Australia

OBJECTIVES: The “Coaching patients On Achieving Cardiovascular Health” (COACH) Program is a structured telephone and mail-out delivered program that trains people with chronic diseases including type 2 diabetes to achieve guideline-recommended target levels for their cardiovascular risk factors while working with their usual medical practitioners. Our aim was to evaluate the long-term cost-effectiveness of this innovative patient education program in type 2 diabetes patients in Tasmania. METHODS: Baseline cohort characteristics and treatment effects were derived from data collected by Diabetes Tasmania in a real life setting at baseline (N=975) and 18 months after a 6-month COACH Program training period. A published and validated simulation model of diabetes (IMS-CORE Diabetes Model) projected 24-month improvements in glycemic control, blood pressure and lipids to quality-adjusted life years (QALYs) and total lifetime direct costs in type 2 diabetes patients with The COACH Program+usual care versus usual care alone.   Australian-specific complication costs were taken from published sources.  The costs of The COACH Program were included. Analyses were run over patient lifetimes and were performed from a third-party payer perspective.  Future costs and QALYs gained were discounted at 5% per annum.  Probabilistic sensitivity analysis was performed. RESULTS: The COACH Program cost AUD1,296/patient to implement. After 6 months, HbA1c improved by mean (standard deviation) 0.35%-points (1.00%-points) from baseline of 7.15% (1.50%), and had a positive effect on lipid profile, BMI and blood pressure, translating into reduced risks of micro- and macrovascular complications, and increased QALYs of mean (95%CI) 0.058(0.023-0.092) years and increased costs of AUD 215(-902 to 1,333) per patient versus usual care alone, with an incremental cost-effectiveness ratio of AUD3,737/QALY gained. CONCLUSIONS: Long-term projections indicated that improved glycemic control, blood pressure and lipid profile sustained over an 18 month period following the 6 month COACH Program is highly cost effective in Type 2 diabetes patients in Tasmania.

Conference/Value in Health Info

2016-09, ISPOR Asia Pacific 2016, Singapore

Value in Health, Vol. 19, No. 7 (November 2016)

Code

PDB25

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Diabetes/Endocrine/Metabolic Disorders

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