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Applying a private sector capitation model to the management of type 2 diabetes in the South African public sector: a cost-effectiveness analysis.

Volmink HC, Bertram MY, Jina R, Wade AN, Hofman KJ - BMC Health Serv Res (2014)

Bottom Line: Probabilistic modelling was utilized for incremental cost-effectiveness ratio analysis with life years gained selected as the outcome.Modelling found an incremental cost-effectiveness ratio (ICER) of ZAR 8 356 (USD 1018) per life year gained (LYG) for the DMP against the usual practice model.Probabilistic modelling found the capitation intervention to be cost-effective, with an ICER of ZAR 8 356 (USD 1018) per LYG.

View Article: PubMed Central - PubMed

Affiliation: Priority Cost Effective Lessons for Systems Strengthening South Africa (PRICELESS SA), MRC/WITS Rural Public Health and Health Transitions Research Unit, Johannesburg, South Africa. karen.hofman@wits.ac.za.

ABSTRACT

Background: Diabetes mellitus contributes substantially to the non-communicable disease burden in South Africa. The proposed National Health Insurance system provides an opportunity to consider the development of a cost-effective capitation model of care for patients with type 2 diabetes. The objective of the study was to determine the potential cost-effectiveness of adapting a private sector diabetes management programme (DMP) to the South African public sector.

Methods: Cost-effectiveness analysis was undertaken with a public sector model of the DMP as the intervention and a usual practice model as the comparator. Probabilistic modelling was utilized for incremental cost-effectiveness ratio analysis with life years gained selected as the outcome. Secondary data were used to design the model while cost information was obtained from various sources, taking into account public sector billing.

Results: Modelling found an incremental cost-effectiveness ratio (ICER) of ZAR 8 356 (USD 1018) per life year gained (LYG) for the DMP against the usual practice model. This fell substantially below the Willingness-to-Pay threshold with bootstrapping analysis. Furthermore, a national implementation of the intervention could potentially result in an estimated cumulative gain of 96 997 years of life (95% CI 71 073 years - 113 994 years).

Conclusions: Probabilistic modelling found the capitation intervention to be cost-effective, with an ICER of ZAR 8 356 (USD 1018) per LYG. Piloting the service within the public sector is recommended as an initial step, as this would provide data for more accurate economic evaluation, and would also allow for qualitative analysis of the programme.

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Related in: MedlinePlus

Flow diagram of study methodology.
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Related In: Results  -  Collection

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Fig1: Flow diagram of study methodology.

Mentions: The study was undertaken in the form of an economic evaluation that utilized probabilistic modelling. The analysis was undertaken for a government perspective, with particular relevance to the review of health service delivery and funding in the public sector. Ethical approval for the study was obtained from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand.A flow diagram summarizing the study methodology is provided in Figure 1. The following key elements described in the figure are detailed below: (1) model development; (2) costing; (3) cost consequences analysis; (4) life table analysis; (5) incremental cost effectiveness ratios (ICERs) and Willingness-to-Pay (WTP) analysis.Figure 1


Applying a private sector capitation model to the management of type 2 diabetes in the South African public sector: a cost-effectiveness analysis.

Volmink HC, Bertram MY, Jina R, Wade AN, Hofman KJ - BMC Health Serv Res (2014)

Flow diagram of study methodology.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4263039&req=5

Fig1: Flow diagram of study methodology.
Mentions: The study was undertaken in the form of an economic evaluation that utilized probabilistic modelling. The analysis was undertaken for a government perspective, with particular relevance to the review of health service delivery and funding in the public sector. Ethical approval for the study was obtained from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand.A flow diagram summarizing the study methodology is provided in Figure 1. The following key elements described in the figure are detailed below: (1) model development; (2) costing; (3) cost consequences analysis; (4) life table analysis; (5) incremental cost effectiveness ratios (ICERs) and Willingness-to-Pay (WTP) analysis.Figure 1

Bottom Line: Probabilistic modelling was utilized for incremental cost-effectiveness ratio analysis with life years gained selected as the outcome.Modelling found an incremental cost-effectiveness ratio (ICER) of ZAR 8 356 (USD 1018) per life year gained (LYG) for the DMP against the usual practice model.Probabilistic modelling found the capitation intervention to be cost-effective, with an ICER of ZAR 8 356 (USD 1018) per LYG.

View Article: PubMed Central - PubMed

Affiliation: Priority Cost Effective Lessons for Systems Strengthening South Africa (PRICELESS SA), MRC/WITS Rural Public Health and Health Transitions Research Unit, Johannesburg, South Africa. karen.hofman@wits.ac.za.

ABSTRACT

Background: Diabetes mellitus contributes substantially to the non-communicable disease burden in South Africa. The proposed National Health Insurance system provides an opportunity to consider the development of a cost-effective capitation model of care for patients with type 2 diabetes. The objective of the study was to determine the potential cost-effectiveness of adapting a private sector diabetes management programme (DMP) to the South African public sector.

Methods: Cost-effectiveness analysis was undertaken with a public sector model of the DMP as the intervention and a usual practice model as the comparator. Probabilistic modelling was utilized for incremental cost-effectiveness ratio analysis with life years gained selected as the outcome. Secondary data were used to design the model while cost information was obtained from various sources, taking into account public sector billing.

Results: Modelling found an incremental cost-effectiveness ratio (ICER) of ZAR 8 356 (USD 1018) per life year gained (LYG) for the DMP against the usual practice model. This fell substantially below the Willingness-to-Pay threshold with bootstrapping analysis. Furthermore, a national implementation of the intervention could potentially result in an estimated cumulative gain of 96 997 years of life (95% CI 71 073 years - 113 994 years).

Conclusions: Probabilistic modelling found the capitation intervention to be cost-effective, with an ICER of ZAR 8 356 (USD 1018) per LYG. Piloting the service within the public sector is recommended as an initial step, as this would provide data for more accurate economic evaluation, and would also allow for qualitative analysis of the programme.

Show MeSH
Related in: MedlinePlus