Improving quality of care in people with Type 2 diabetes through the Associazione Medici Diabetologi‐annals initiative: a long‐term cost‐effectiveness analysis

Giorda, Carlo; Nicolucci, Antonio; Pellegrini, Fabio; Kristiansen, Camilla; Hunt, Barnaby; Valentine, William J.; Vespasiani, G

doi:10.1111/dme.12366

Cited by 16 publications

(13 citation statements)

References 21 publications

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“…In seven studies based on controlled before-after designs, the ICER was $104,132 per QALY in one subpopulation (34), $50,000-$99,999 per QALY in one subpopulation (35), and $0-$49,999 per QALY in five studies or study subpopulations (33,34,43). In seven studies based on uncontrolled before-after and other designs, the ICER was $50,000-$99,999 per QALY in one study (44), $0-$49,999 per QALY in four studies (45)(46)(47)(48), and dominant with more than $5,000 in net savings in two studies due to avoiding complications including renal disease (49,50).…”

Section: Short-term Costsmentioning

confidence: 94%

Economic Evaluation of Quality Improvement Interventions Designed to Improve Glycemic Control in Diabetes: A Systematic Review and Weighted Regression Analysis

et al. 2018

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OBJECTIVEQuality improvement (QI) interventions can improve glycemic control, but little is known about their value. We systematically reviewed economic evaluations of QI interventions for glycemic control among adults with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODSWe used English-language studies from high-income countries that evaluated organizational changes and reported program and utilization-related costs, chosen from PubMed, EconLitWe extracted data regarding intervention, study design, change in HbA 1c , time horizon, perspective, incremental net cost (studies lasting £3 years), incremental costeffectiveness ratio (ICER) (studies lasting ‡20 years), and study quality. Weighted least-squares regression analysis was used to estimate mean changes in HbA 1c and incremental net cost. RESULTSOf 3,646 records, 46 unique studies were eligible. Across 19 randomized controlled trials (RCTs), HbA 1c declined by 0.26% (95% CI 0.17-0.35) or 3 mmol/mol (2 to 4) relative to usual care. In 8 RCTs lasting £3 years, incremental net costs were $116 (95% CI 2$612 to $843) per patient annually. Long-term ICERs were $100,000-$115,000/quality-adjusted life year (QALY) in 3 RCTs, $50,000-$99,999/QALY in 1 RCT, $0-$49,999/QALY in 4 RCTs, and dominant in 1 RCT. Results were more favorable in non-RCTs. Our limitations include the fact that the studies had diverse designs and involved moderate risk of bias. CONCLUSIONSDiverse multifaceted QI interventions that lower HbA 1c appear to be a fair-to-good value relative to usual care, depending on society's willingness to pay for improvements in health.

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Section: Short-term Costsmentioning

confidence: 94%

Economic Evaluation of Quality Improvement Interventions Designed to Improve Glycemic Control in Diabetes: A Systematic Review and Weighted Regression Analysis

et al. 2018

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“…Process measures are expressed as percentages of patients monitored at least once during the previous 12 months for the following parameters: glycated hemoglobin (HbA1c), blood pressure (BP), lipid profile (LDL cholesterol or total and HDL cholesterol and triglycerides), renal function, and eye examination [ 9 – 14 ].…”

Section: Methodsmentioning

confidence: 99%

“…Unsatisfactory outcomes include HbA1c levels >8.0%, blood pressure values ≥140/90 mmHg, LDL levels ≥130 mg/dl, BMI ≥30 Kg/m 2 , presence of micro/macroalbuminuria (MAU), and glomerular filtration rate (GFR) ≤60 ml/min. Indicators of treatment intensity/appropriateness are also measured, taking into consideration the use of pharmacologic treatments in relation to the achievement of the targets: no lipid-lowering agents despite LDL-c ≥130 mg/dl, no antihypertensive treatments despite BP≥140/90 mmHg, no angiotensin converting enzyme inhibitors (ACE-Is) and/or angiotensin receptor blockers (ARBs) despite MAU, HbA1c> = 9.0% in spite of insulin therapy, LDL-c ≥130 mg/dl in spite of lipid-lowering treatment, and BP ≥140/90 mmHg in spite of antihypertensive treatment [ 9 – 14 ].…”

Section: Methodsmentioning

confidence: 99%

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Gender-Disparities in Adults with Type 1 Diabetes: More Than a Quality of Care Issue. A Cross-Sectional Observational Study from the AMD Annals Initiative

et al. 2016

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We evaluated gender-differences in quality of type 1 diabetes (T1DM) care. Starting from electronic medical records of 300 centers, 5 process indicators, 3 favorable and 6 unfavorable intermediate outcomes, 6 treatment intensity/appropriateness measures and an overall quality score were measured. The likelihood of women vs. men (reference class) to be monitored, to reach outcomes, or to be treated has been investigated through multilevel logistic regression analyses; results are expressed as Odd Ratios (ORs) and 95% confidence intervals (95%CIs). The inter-center variability in the achievement of the unfavorable outcomes was also investigated. Overall, 28,802 subjects were analyzed (45.5% women). Women and men had similar age (44.5±16.0 vs. 45.0±17.0 years) and diabetes duration (18.3±13.0 vs. 18.8±13.0 years). No between-gender differences were found in process indicators. As for intermediate outcomes, women showed 33% higher likelihood of having HbA1c ≥8.0% (OR = 1.33; 95%CI: 1.25–1.43), 29% lower risk of blood pressure ≥140/90 mmHg (OR = 0.71; 95%CI: 0.65–0.77) and 27% lower risk of micro/macroalbuminuria (OR = 0.73; 95%CI: 0.65–0.81) than men, while BMI, LDL-c and GFR did not significantly differ; treatment intensity/appropriateness was not systematically different between genders; overall quality score was similar in men and women. Consistently across centers a larger proportion of women than men had HbA1c ≥8.0%, while a smaller proportion had BP ≥140/90 mmHg. No gender-disparities were found in process measures and improvements are required in both genders. The systematic worse metabolic control in women and worse blood pressure in men suggest that pathophysiologic differences rather than the care provided might explain these differences.

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“…We analyzed a series of patients with T2DM followed-up by a network of 10 outpatient diabetes centers (DCs) from AID (Associazione Italiana Diabete) participating in the so called Associazione Medici Diabetologi (AMD) Annals Initiative, all having the same organization structure and previously documented to attain the same performance levels and therefore considered to be a single institution. 20 Participating DCs adopted the same software for everyday outpatient management. A dedicated software package allowed data extraction for further analysis (AMD Data File).…”

Section: Methodsmentioning

confidence: 99%

Short-term Cardio-Vascular Risk Score Changes in Type 2 Diabetic Patients on Empaglifozin: A Real-Life Clinical Experience

Fusco¹,

Colarusso²,

Piscopo³

et al. 2017

Heart Res Open J

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CitationFusco A, Colarusso S, Piscopo M, et al. Short-term cardio-vascular The aim of the study was to test both efficacy and safety of empaglifozin in type 2 diabetic out patients followed-up within a single institution. Materials and Methods: One hundred seventy-eight consecutive patients treated with empaglifozin for 6 months were compared to 356 fully matched control patients on alternative drugs: side effects were monitored and changes from baseline were evaluated for body weight, body mass index (BMI), blood pressure, circulating glucose, HbA1c, uric acid, triglycerides, total, high density lipoprotein (HDL) and low density lipoprotein (LDL)-cholesterol levels, as well as creatinine clearance rate. The 10-year Cardiovascular Risk score (10-y CV-RS) was also assessed in all patients according to the cryogenic underground observatory for rare events (CUORE) calculation charts. Weight, BMI, systolic and diastolic blood pressure, as well as, HbA1c, glucose, cholesterol, triglyceride and uric acid levels, significantly decreased after treatment, along with the 10-y CV-RS which is in fact strongly related to the above. Results: Virtually no changes were observed in creatinine clearance rate and HDL levels. 45% patients reported polyuria, 15% genital itching, 8% genital infections, 12% urinary tract infections, no volume depletion or keto-acidosis episodes were described. Conclusion: In conclusion, in diabetic patients experiencing no previous major cardiovascular events, empaglifozin significantly improved all cardiovascular risk factors, including glucose control, and the 10-y CV-RS. Moreover it was well tolerated, so that no treatment discontinuation was needed even in case of urinary tract infections.

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Improving quality of care in people with Type 2 diabetes through the Associazione Medici Diabetologi‐annals initiative: a long‐term cost‐effectiveness analysis

Abstract: Long-term projections indicate that the physician-led Associazione Medici Diabetologi-annals initiative represents a cost-saving method of improving long-term clinical outcomes compared with conventional management of people with Type 2 diabetes in Italy.

Cited by 16 publications

References 21 publications

Economic Evaluation of Quality Improvement Interventions Designed to Improve Glycemic Control in Diabetes: A Systematic Review and Weighted Regression Analysis

Economic Evaluation of Quality Improvement Interventions Designed to Improve Glycemic Control in Diabetes: A Systematic Review and Weighted Regression Analysis

Gender-Disparities in Adults with Type 1 Diabetes: More Than a Quality of Care Issue. A Cross-Sectional Observational Study from the AMD Annals Initiative

Short-term Cardio-Vascular Risk Score Changes in Type 2 Diabetic Patients on Empaglifozin: A Real-Life Clinical Experience

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