S G Sosa-Rubí1, D Contreras-Loya2, D Pedraza-Arizmendi3, C Chivardi-Moreno3, F Alarid-Escudero4, R López-Ridaura5, E Servan-Mori6, V Molina-Cuevas7, G Casales-Hernández5, C Espinosa-López8, J F González-Roldán9, R Silva-Tinoco10, J Seiglie11, O Gómez-Dantés6. 1. Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP). Electronic address: srubi@insp.mx. 2. University of California, Berkeley, California, USA. 3. Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP). 4. Division of Public Administration, Center for Research and Teaching in Economics, Aguascalientes, Mexico. 5. National Center for Disease Prevention and Control Programs (CENAPRECE), Ministry of Health, Mexico. 6. Health System Research Center, National Institute of Public Health (INSP). 7. Pan American Health Organization, Mexico City Office, Mexico. 8. Independent Consultant. Medical Epidemiologist, Mexico. 9. Mexican Society of Public Health, Civil Organization, Mexico. 10. Specialized Clinic in Diabetes Management, Mexico City-Iztapalapa, Ministry of Health/ Ministry of Health in Mexico City. 11. Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA.
Abstract
OBJECTIVE: In 2007, the Ministry of Health (MoH) in Mexico implemented a multidisciplinary health-care model (MHC) for patients with type-2 diabetes (T2D), which has proven more effective in controlling this condition than the conventional health-care model (CHC). RESEARCH DESIGN AND METHODS: We compared the cost-effectiveness of the MHC vs. the CHC for patients with T2D using a quasi-experimental, retrospective design. Epidemiologic and cost data were obtained from a randomly selected sample of health-care units, using medical records as well as patient- and facility-level data. We modelled the cost-effectiveness of the MHC at one, 10 and 20 years using a simulation model. RESULTS: The average cumulative costs per patient at 20 years were US$4,225 for the MHC and US$4,399 for the CHC. With a willingness to pay one gross domestic product (GDP) per capita per quality-adjusted life year (QALY) (US$8,910), the incremental net benefits per patient were US$1,450 and US$3,737 at 10 and 20 years, respectively. The MHC was cost-effective from the third year onward; however, increasing coverage to 500 patients per year rendered it cost-effective at year one. CONCLUSIONS: The MHC is cost-effective at 10 and 20 years. Cost-effectiveness can be achieved in the short term by increasing MHC coverage.
OBJECTIVE: In 2007, the Ministry of Health (MoH) in Mexico implemented a multidisciplinary health-care model (MHC) for patients with type-2 diabetes (T2D), which has proven more effective in controlling this condition than the conventional health-care model (CHC). RESEARCH DESIGN AND METHODS: We compared the cost-effectiveness of the MHC vs. the CHC for patients with T2D using a quasi-experimental, retrospective design. Epidemiologic and cost data were obtained from a randomly selected sample of health-care units, using medical records as well as patient- and facility-level data. We modelled the cost-effectiveness of the MHC at one, 10 and 20 years using a simulation model. RESULTS: The average cumulative costs per patient at 20 years were US$4,225 for the MHC and US$4,399 for the CHC. With a willingness to pay one gross domestic product (GDP) per capita per quality-adjusted life year (QALY) (US$8,910), the incremental net benefits per patient were US$1,450 and US$3,737 at 10 and 20 years, respectively. The MHC was cost-effective from the third year onward; however, increasing coverage to 500 patients per year rendered it cost-effective at year one. CONCLUSIONS: The MHC is cost-effective at 10 and 20 years. Cost-effectiveness can be achieved in the short term by increasing MHC coverage.
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