A model to predict the cost-effectiveness of disease management programs.

High costs and deficits in the care of patients with chronic diseases have triggered numerous programs to improve the quality and efficiency of treatment of chronic diseases. Decision makers need to estimate the impact of a disease management program (DMP) on long-term costs and cost-effectiveness in order to decide which programs to introduce. This prediction, however, requires formalizing the relations between a variety of variables. The purpose of this paper is to formalize these relations and develop a model that enhances the quality of predictions of the costs and cost-effectiveness of a DMP. The model's cost function is able to portray a reduction both of treatment overuse and underuse by improving both physician and patient compliance. The model's applicability is demonstrated by a simulated DMP for patients with hypertension. The application example shows that implementation costs may have a larger financial impact than downstream costs.