Long-term cost-effectiveness of quality of diabetes care; experiences from private and public diabetes centers in Iran

Rahill Sadat Shahtaheri (), Yahya Bayazidi (), Majid Davari (), Abbas Kebriaeezadeh (), Sepideh Yousefi (), Alireza Mahdavi Hezaveh (), Abolfazl Sadeghi (), Ahmed Hayder Mohsin Lami () and Hadi Abbasian ()
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Rahill Sadat Shahtaheri: Tehran University of Medical Sciences
Yahya Bayazidi: Tehran University of Medical Sciences
Majid Davari: Tehran University of Medical Sciences
Abbas Kebriaeezadeh: Tehran University of Medical Sciences
Sepideh Yousefi: Islamic adad university
Alireza Mahdavi Hezaveh: Tehran University of Medical Sciences
Abolfazl Sadeghi: Faculty of Pharmacy, Tehran University of Medical Sciences
Ahmed Hayder Mohsin Lami: Faculty of Pharmacy, Tehran University of Medical Sciences
Hadi Abbasian: Tehran University of Medical Sciences

Health Economics Review, 2022, vol. 12, issue 1, 1-7

Abstract: Abstract Background The quality of health care has a significant impact on both patients and the health system in terms of long-term costs and health consequences. This study focuses on determining the long-term cost-effectiveness in quality of diabetes care in two different settings (private/public) using longitudinal patient-level data in Iran. Methods By extracting patients intermediate biomedical markers in under-treatment type 2 diabetes patients(T2DP) in a longitudinal retrospective study and by applying the localized UKPDS diabetes model, lifetime health outcomes including life expectancy, quality-adjusted Life expectancy (QALE) and direct medical costs of managing disease and related complications from a healthcare system perspective was predicted. Costs and utility decrements had derived on under-treatment T2DP from 7 private and 8 Public diabetes centers. We applied two steps sampling mehods to recruit the needed sample size (cluster and random sampling). To cope with first and second-order uncertainty, we used Monte-Carlo simulation and bootstrapping techniques. Both cost and utility variables were discounted by 3% in the base model. Results In a 20-year time horizon, according to over 5 years of quality of care data, outcomes-driven in the private sector will be more effective and more costly (5.17 vs. 4.95 QALE and 15,385 vs. 8092). The incremental cost-effectiveness ratio (ICER) was $33,148.02 per QALE gained, which was higher than the national threshold. Conclusion Although quality of care in private diabetes centers resulted in a slight increase in the life expectancy in T2DM patients, it is associated with unfavorable costs, too. Private-sector in management of T2DM patients, compared with public (governmental) diabetic Centers, is unlikely to be cost-effective in Iran.

Keywords: Type 2 diabetes mellitus; Localized UKPDS model; Private sector; Public sector; Cost-effectiveness analysis; Quality of care; Iran (search for similar items in EconPapers)
Date: 2022
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DOI: 10.1186/s13561-022-00377-9

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