Community-based integrated care versus hospital outpatient care for managing patients with complex type 2 diabetes: costing analysis.
- Resource Type
- Article
- Authors
- Donald, Maria; Jackson, Claire L.; Byrnes, Joshua; Vaikuntam, Bharat Phani; Russell, Anthony W.; Hollingworth, Samantha A.
- Source
- Australian Health Review. 2021, Vol. 45 Issue 1, p42-50. 9p.
- Subject
- *COMMUNITY health services
*ECONOMIC aspects of diseases
*ENDOCRINOLOGISTS
*HOSPITALS
*OUTPATIENT services in hospitals
*INTEGRATED health care delivery
*INTERVIEWING
*MEDICAL care costs
*MEDICAL referrals
*TYPE 2 diabetes
*NURSES
*RESEARCH funding
*DATA analysis software
*DESCRIPTIVE statistics
- Language
- ISSN
- 0156-5788
Objective. This study compared the cost of an integrated primary-secondary care general practitioner (GP)-based Beacon model with usual care at hospital outpatient departments (OPDs) for patients with complex type 2 diabetes. Methods. A costing analysis was completed alongside a non-inferiority randomised control trial. Costs were calculated using information from accounting data and interviews with clinic managers. Two OPDs and three GP-based Beacon practices participated. In the Beacon practices, GPs with a special interest in advanced diabetes care worked with an endocrinologist and diabetes nurse educator to care for referred patients. The main outcome was incremental cost saving per patient course of treatment from a health system perspective. Uncertainty was characterised with probabilistic sensitivity analysis using Monte Carlo simulation. Results. The Beacon model is cost saving: the incremental cost saving per patient was A$365 (95% confidence interval -A$901, A$55) and was cost saving in 93.7% of simulations. The key contributors to the variance in the cost saving per patient course of treatment were the mean number of patients seen per site and the number of additional presentations per course of treatment associated with the Beacon model. Conclusions. Beacon clinics were less costly per patient course of treatment than usual care in hospital OPDs for equivalent clinical outcomes. Local contractual arrangements and potential variation in the operational cost structure are of significant consideration in determining the cost-efficiency of Beacon models. [ABSTRACT FROM AUTHOR]