Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting

Abstract

Objective: We evaluated the cost-effectiveness of the point-of-care A1c (POC-A1c) test device vs. the traditional laboratory dosage in a primary care setting for people living with type 2 diabetes.Materials and Methods: The Markov model with a 10-year time horizon was based on data from the HealthRise project, in which a group of interventions was implemented to improve diabetes and hypertension control in the primary care network of the urban area of a Brazilian municipality. A POC-A1c device was provided to be used directly in a primary care unit, and for a period of 18 months, 288 patients were included in the point-of-care group, and 1,102 were included in the comparison group. Sensitivity analysis was performed via Monte Carlo simulation and tornado diagram.Results: The results indicated that the POC-A1c device used in the primary care unit was a cost-effective alternative, which improved access to A1c tests and resulted in an increased rate of early control of blood glucose. In the 10-year period, POC-A1c group presented a mean cost of US$10,503.48 per patient and an effectiveness of 0.35 vs. US$9,992.35 and 0.09 for the traditional laboratory test, respectively. The incremental cost was US$511.13 and the incremental effectiveness was 0.26, resulting in an incremental cost-effectiveness ratio of 1,947.10. In Monte Carlo simulation, costs and effectiveness ranged between $9,663.20–$10,683.53 and 0.33–0.37 for POC-A1c test group, and $9,288.28–$10,413.99 and 0.08–0.10 for traditional laboratory test group, at 2.5 and 97.5 percentiles. The costs for nephropathy, retinopathy, and cardiovascular disease and the probability of being hospitalized due to diabetes presented the greatest impact on the model’s result.Conclusion: This study showed that using POC-A1c devices in primary care settings is a cost-effective alternative for monitoring glycated hemoglobin A1c as a marker of blood glucose control in people living with type 2 diabetes. According to our model, the use of POC-A1c device in a healthcare unit increased the early control of type 2 diabetes and, consequently, reduced the costs of diabetes-related outcomes, in comparison with a centralized laboratory test.

Physicians’ and nurses’ perspective on chronic disease care practices in Primary Health Care in Brazil: a qualitative study

“…Opportunities were identified in services that use multiple care technologies towards providing comprehensive care for NCD. Innovative technologies used in local PHC, like the fingertip glycated hemoglobin tester and home blood pressure monitoring, were identified as facilitators for improving access to glycemic and pressure control, both in screening and therapeutic follow-up actions [34,35]. The reception and bonding are also recognized as a technology of relationships and advocated in Brazil, as a care practice based on the lasting and authentic relationship, mutual understanding, and sense of affiliation [36], stimulating lifestyle changes, and increasing responsibilities and adherence to treatment [22,31], however more difficult to operationalize due to the great demand for individual care.…”

Improving Access to the Glycated Hemoglobin Test in Rural Communities With Point-of-Care Devices: An Application Study

“…These complications, in addition to significantly affecting the quality of life and survival of people with diabetes, have a high financial impact on health systems. In Brazil, the available data have attributed an average annual cost with complications related to diabetes between 112.90 and 3917.00 dollars per patient/patient/year, which depends on the type of complication presented, resulting from inadequate control ( 17 ). When considering these values, the estimated cost for the local health system with complications related to diabetes ranges from 17,047.90 to 591,467.00 dollars, only for patients from these four locations whose HbA1c levels were higher than the control threshold.…”

“…The initiative made it possible to measure HbA1c in people who needed it in these areas. In addition, we recently demonstrated that this type of technology can be cost-effective if applied in primary care units in urban areas ( 17 ). Given the findings obtained with the application of point-of-care for HbA1c measurement in rural communities, we believe that the cost-effectiveness ratio of the initiative is even more favorable when compared to testing in laboratories.…”

“…In addition, in the Brazilian scenario, the results of the test performed in laboratories are not immediately available, which may mean an even greater delay in reviewing the treatment of a patient with uncontrolled glycemia or in confirming a new diagnosis. On the other hand, the use of point-of-care devices to measure HbA1c has been shown to be cost-effective in the care of DM patients in primary care, with the possibility of improving glycemic control rates in a timely manner to reduce the development of DM-related complications, and consequently, their economic impact on health systems ( 17 ). Therefore, this study aimed to evaluate the application of point-of-care technology for HbA1c estimation in the assessment of glycemic control and identification of new diagnoses of diabetes in primary care among rural communities in a Brazilian municipality.…”

Community-Based Interventions to Improve the Control of Non-Communicable Diseases in Underserved Rural Areas in Brazil: A Before-and-After Study

“…For diabetic patients, HbA1c levels were measured using the portable Abbott Afinion ™ two Analyzer, a point-of-care device that allows for instant evaluation without needing to visit a clinical laboratory. In a study, "the Cost-Effectiveness study of Point-of-Care A1C Tests in a Primary Care Setting," because the point-of-care testing of HbA1c levels resulted in an increase in the rate of diabetes control, the higher purchase costs of the point-ofcare testing compared to that of laboratory tests, were reportedly offset by the savings from the reduction in diabetes-related complications and hospitalizations (Rosa et al, 2021). BP and HbA1c levels were measured again within 3 months of the intervention, for each patient.…”