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

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.

Health seeking behaviours and private sector delivery of care for non-communicable diseases in low- and middle-income countries: a systematic review

“…With regard to outcomes of care , a number of studies [ 70 , 76 , 113 , 120 – 122 ] found that the private sector performed better than the public sector, but there were relatively few studies that controlled for disease stage, severity, risk factors, comorbidities or the background of patients, which are often different between the two sectors [ 61 , 73 – 76 ]. One study in Malaysia that did control for such differences found that lower cancer survival rates in the public sector were unlikely to be related to disparities in treatment, highlighting the need for earlier diagnosis of the uninsured and people from lower socioeconomic classes [ 119 ].…”