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Cost-Effectiveness of a Diabetes Pay-For-Performance Program in Diabetes Patients with Multiple Chronic Conditions

Author

Listed:
  • Hui-Min Hsieh
  • Song-Mao Gu
  • Shyi-Jang Shin
  • Hao-Yun Kao
  • Yi-Chieh Lin
  • Herng-Chia Chiu

Abstract

Pay for performance (P4P) has been used as a strategy to improve quality for patients with chronic illness. Little was known whether care provided to individuals with multiple chronic conditions in a P4P program were cost-effective. This study investigated cost effectiveness of a diabetes P4P program for caring patients with diabetes alone (DM alone) and diabetes with comorbid hypertension and hyperlipidemia (DMHH) from a single payer perspective in Taiwan. Analyzing data using population-based longitudinal databases, we compared costs and effectiveness between P4P and non-P4P diabetes patient groups in two cohorts. Propensity score matching (PSM) was used to match comparable control groups for intervention groups. Outcomes included life-years, quality-adjusted life-years (QALYs), program intervention costs, cost-savings and incremental cost-effectiveness ratios (ICERs). QALYs for P4P patients and non-P4P patients were 2.80 and 2.71 for the DM alone cohort and 2.74 and 2.66 for the DMHH patient cohort. The average incremental intervention costs per QALYs was TWD$167,251 in the DM alone cohort and TWD$145,474 in the DMHH cohort. The average incremental all-cause medical costs saved by the P4P program per QALYs were TWD$434,815 in DM alone cohort and TWD$506,199 in the DMHH cohort. The findings indicated that the P4P program for both cohorts were cost-effective and the resulting return on investment (ROI) was 2.60:1 in the DM alone cohort and 3.48:1 in the DMHH cohort. We conclude that the diabetes P4P program in both cohorts enabled the long-term cost-effective use of resources and cost-savings, especially for patients with multiple comorbid conditions.

Suggested Citation

  • Hui-Min Hsieh & Song-Mao Gu & Shyi-Jang Shin & Hao-Yun Kao & Yi-Chieh Lin & Herng-Chia Chiu, 2015. "Cost-Effectiveness of a Diabetes Pay-For-Performance Program in Diabetes Patients with Multiple Chronic Conditions," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-15, July.
    • Handle: RePEc:plo:pone00:0133163
    DOI: 10.1371/journal.pone.0133163
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    References listed on IDEAS

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    1. Martin Emmert & Frank Eijkenaar & Heike Kemter & Adelheid Esslinger & Oliver Schöffski, 2012. "Economic evaluation of pay-for-performance in health care: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(6), pages 755-767, December.
    2. Eijkenaar, Frank & Emmert, Martin & Scheppach, Manfred & Schöffski, Oliver, 2013. "Effects of pay for performance in health care: A systematic review of systematic reviews," Health Policy, Elsevier, vol. 110(2), pages 115-130.
    3. Rajeev H. Dehejia & Sadek Wahba, 2002. "Propensity Score-Matching Methods For Nonexperimental Causal Studies," The Review of Economics and Statistics, MIT Press, vol. 84(1), pages 151-161, February.
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    1. Elizabeth Parody-Rúa & Maria Rubio-Valera & César Guevara-Cuellar & Ainhoa Gómez-Lumbreras & Marc Casajuana-Closas & Cristina Carbonell-Duacastella & Ignacio Aznar-Lou, 2020. "Economic Evaluations Informed Exclusively by Real World Data: A Systematic Review," IJERPH, MDPI, vol. 17(4), pages 1-18, February.
    2. Karen Eggleston & Brian K. Chen & Chih-Hung Chen & Ying Isabel Chen & Talitha Feenstra & Toshiaki Iizuka & Janet Tin Kei Lam & Gabriel M. Leung & Jui-fen Rachel Lu & Beatriz Rodriguez-Sanchez & Jeroen, 2020. "Are quality-adjusted medical prices declining for chronic disease? Evidence from diabetes care in four health systems," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(5), pages 689-702, July.

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