The cost and cost implications of implementing the integrated chronic disease management model in South Africa

Abstract

BackgroundA cost analysis of implementation of interventions informs budgeting and economic evaluations. ObjectiveTo estimate the cost of implementing the integrated chronic disease management (ICDM) model in primary healthcare (PHC) clinics in South Africa. MethodsCost data from the provider's perspective were collected in 2019 from four PHC clinics with comparable patient caseloads (except for one). We estimated the costs of implementing the ICDM model current activities for three (facility reorganization, clinical supportive management and assisted self-management) components and additional costs of implementing with enhanced fidelity. Costs were estimated based on budget reviews, interviews with management teams, and other published data. The standard of care activities such as medication were not included in the costing. One-way sensitivity analyses were carried out for key parameters by varying patient caseloads, required infrastructure and staff. Annual ICDM model implementation costs per PHC clinic and per patient per visit are presented in 2019 US dollars.

The Comorbidity of HIV, Hypertension and Diabetes: A Qualitative Study Exploring the Challenges Faced by Healthcare Providers and Patients in Selected Urban and Rural Health Facilities where the ICDM Model is Implemented in South Africa

“…Health system ine ciencies such as lack of staff and unclear guidelines for the care of patients with multi-morbidities threaten the successful implementation of the Integrated Chronic Disease Model (17). Research suggests that current budgeted costs for implementing the ICDM model are su cient however minimal additional costs are required for improving patient ow, managing bookings and the training of staff (27).…”

“…However, it is important for health systems to be transparent about the di culties in delivering this component. The scale up of this component can improve adherence and provide relief to overcrowded health facilities (27).…”

“…They report receiving minimal information about managing HIV chronic comorbidities and the absence of support groups. We acknowledge that implementing achieving the outcome of individual responsibility through providing assisted self-management is among the costliest components of the ICDM model (27). However, it is important for health systems to be transparent about the di culties in delivering this component.…”

Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings

“…Responding to the growing burden of chronic diseases including diabetes, South Africa adopted an Integrated Chronic Disease Management (ICDM) model which aims to reduce healthcare utilisation and promotes self-management among patients with chronic conditions. 24 , 25 The ICDM goal is to achieve optimal clinical outcomes for people living with chronic communicable and non-communicable diseases. 26 The ICDM has four inter-related phases: (1) facility re-organisation to improve service efficiency, (2) clinical supportive management to improve quality of clinical care, (3) ‘assisted’ self-support and management of patients through primary healthcare ward-based outreach teams (WBOT) to enhance self-care and raise awareness of chronic diseases in communities and (4) strengthening support systems and structures outside the health facility to ensure a fully functional and responsive health system.…”

“…Responding to the growing burden of chronic diseases including diabetes, South Africa adopted an Integrated Chronic Disease Management (ICDM) model which aims to reduce healthcare utilisation and promotes self-management among patients with chronic conditions. 24,25 The ICDM goal is to achieve optimal clinical outcomes for people living with chronic communicable and non-communicable diseases. 26 The ICDM has four inter-related phases:…”