Economic Analysis of a Telemedicine Intervention to Improve Glycemic Control in Patients with Diabetes Mellitus
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Background and objective
An economic analysis of telemedicine support to improve glycemic control in patients with type 2 diabetes mellitus, illustrating the use of an analytic framework that efficiently combines telemedicine program findings with published estimates of treatment cost effectiveness.
The Pro-Active Call Centre Treatment Support (PACCTS) trial compared tailored, protocol-driven call-center support with usual care as methods to manage glycemic control in 591 patients with diabetes in Salford, UK. Economic analysis of the trial describes the cost of delivering telemedicine support and level of improved glycemic control achieved in patients. These findings are linked to current best evidence for the long-term cost effectiveness of treatment to help inform whether the provision of call-center support to improve glycemic control should become routine health policy.
Under trial conditions, the cost effectiveness of the PACCTS intervention was estimated to be £43 400/ quality-adjusted life-year (QALY) [2003 costings]. Under routine-use call-center conditions (a full caseload of patients with moderate to poor glycemic control) cost effectiveness was estimated to be lower at £33 700/QALY. Set against a threshold of £30 000/QALY, Monte Carlo simulation suggests the probability of PACCTS being cost-effective in routine use is 29%.
Despite being received well by patients and healthcare professionals alike, telemedicine support solely to achieve improved glycemic control in patients with type 2 diabetes was found to be borderline cost effective. Major uncertainties that could change this result include the underlying cost effectiveness of improved glycemic control, which is currently imprecisely known. Research is ongoing in patients with type 2 diabetes to extend call-center support to improve blood pressure and lipid management, where if similar improvements are obtained, the call center should prove highly cost effective. The novel analytic approach illustrated provides a clear framework for thinking about the design and analysis of behavioral change policies for healthcare.
KeywordsMetformin Cost Effectiveness Glycemic Control Call Center Policy Model
This work was funded as part of an unrestricted academic (sub-contract) grant from Salford Hospital NHS Trust to provide research support, with funds originating from the study sponsors Glaxo Smith Kline and British Telecom. British Telecom acted as technology partners funding call center equipment and development and maintenance costs of the PACCTS trial. British Telecom is planning to market the PACCTS software. The authors have no other conflicts of interests that are directly relevant to the contents of this study. Ethical Approval: Salford & Trafford Research Ethics Committee (project 00199). This analysis was conceived and conducted by James M. Mason, assisted by Robert J. Young and John P. New. All authors contributed to interpreting findings and writing the paper.
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