Article
Disease Management Program Evaluation in Austria: Secondary Use of Routine Health Insurance Data
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Authors
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Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
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Andrea Berghold
- Medizinische Univeristät Graz, Institut für Medizinische Informatik, Statistik und Dokumentation
| Published: | March 6, 2018 |
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Outline
Text
Background: In 2007 a disease management program (DMP) for patients with diabetes type II was implemented in Austria based on optional and free of charge participation of general practitioners and patients. An evaluation of the impact of the DMP is essential however it is rarely integrated in the roll-out of the program. Routine health insurance data provide a useful tool for evaluation of implemented DMPs.
Material/Methods: In Austria, insurance data on patients with diabetes type II were provided to evaluate the DMP. A population-based retrospective cohort study was conducted considering patient-relevant outcomes (overall mortality, cardiovascular disease) and economic impact over a four years follow-up. Patients who enrolled in the program during 2008 and 2009 (n=7181) were compared to non-participants of the program with similar health profiles. The controls with diabetes type II in the routine health insurance database (n=208.532) were identified based on antidiabetic drug therapy. A comparable control group was derived using a propensity score matching (PSM) approach taking patient characteristics, form of antidiabetic therapy, other prescriptions, number of hospital admissions and days, main discharge diagnoses and costs into account.
Results: Before matching large imbalances were observed for age, the form of antidiabetic therapy, total costs and hospital days, indicating that DMP participants tended to be younger and healthier compared to non-participants. After matching no substantial imbalances were observed for all our measured baseline characteristics. Over the follow-up period of four years, we observed a significantly lower mortality rate (9.4% in DMP group vs. 15.9% in control group; p<0.001) and a reduction in total costs for the DMP participants in comparison to the control group.
Conclusion: By using PSM, we were able to ensure comparable groups for a large number of measured confounders, however we cannot rule out an influence by unmeasured confounding. Despite these limitations our results indicate a survival benefit and an average reduction of costs for participants in the DMP compared with the controls.
References
- 1.
- Riedl R, Robausch M, Berghold A. The evaluation of the effectiveness of Austrians Disease Management Program in patients with type 2 diabetes mellitus - A population-based retrospective cohort study. PLoS ONE. 2016;11(8):e0161429.
