TY - JOUR
T1 - Community-based integrated care versus hospital outpatient care for managing patients with complex type 2 diabetes
T2 - costing analysis
AU - Donald, Maria
AU - Jackson, Claire L.
AU - Byrnes, Joshua
AU - Vaikuntam, Bharat Phani
AU - Russell, Anthony W.
AU - Hollingworth, Samantha A.
N1 - Funding Information:
This research was funded by the National Health and Medical Research Council via the Centre of Research Excellence in Quality and Safety in Integrated Primary-Secondary Care (Grant no. GNT1001157). The authors thank the clinical, administrative and managerial staff of each of the study sites who made this study possible.
Funding Information:
Beacon clinics were funded from several sources. The endocrinologist and DNE were funded by the state hospital, whereas the two GPwSIs and administration staff were remunerated by the general practice, which also covered overheads associated with the Beacon clinic. Beacon clinics received funding from the Australian Government for eligible services (fee for service) via Medicare for items included on the Medicare Benefit Schedule (MBS).
Publisher Copyright:
© 2021 Journal Compilation AHHA Open Access.
PY - 2021/2
Y1 - 2021/2
N2 - Objective: This study compared the cost of an integrated primary-secondary care general practitioner (GP)-based Beacon model with usual care at hospital outpatient departments (OPDs) for patients with complex type 2 diabetes. Methods: A costing analysis was completed alongside a non-inferiority randomised control trial. Costs were calculated using information from accounting data and interviews with clinic managers. Two OPDs and three GP-based Beacon practices participated. In the Beacon practices, GPs with a special interest in advanced diabetes care worked with an endocrinologist and diabetes nurse educator to care for referred patients. The main outcome was incremental cost saving per patient course of treatment from a health system perspective. Uncertainty was characterised with probabilistic sensitivity analysis using Monte Carlo simulation. Results: The Beacon model is cost saving: The incremental cost saving per patient was A$365 (95% confidence interval-A$901, A$55) and was cost saving in 93.7% of simulations. The key contributors to the variance in the cost saving per patient course of treatment were the mean number of patients seen per site and the number of additional presentations per course of treatment associated with the Beacon model. Conclusions: Beacon clinics were less costly per patient course of treatment than usual care in hospital OPDs for equivalent clinical outcomes. Local contractual arrangements and potential variation in the operational cost structure are of significant consideration in determining the cost-efficiency of Beacon models. What is known about this topic?: Despite the growing importance of achieving care quality within constrained budgets, there are few costing studies comparing clinically-equivalent hospital and community-based care models. What does this paper add?: Costing analyses comparing hospital-based to GP-based health services require considerable effort and are complex. We show that GP-based Beacon clinics for patients with complex chronic disease can be less costly per patient course of treatment than usual care offered in hospital OPDs. What are the implications for practitioners?: In addition to improving access and convenience for patients, transferring care from hospital to the community can reduce health system costs.
AB - Objective: This study compared the cost of an integrated primary-secondary care general practitioner (GP)-based Beacon model with usual care at hospital outpatient departments (OPDs) for patients with complex type 2 diabetes. Methods: A costing analysis was completed alongside a non-inferiority randomised control trial. Costs were calculated using information from accounting data and interviews with clinic managers. Two OPDs and three GP-based Beacon practices participated. In the Beacon practices, GPs with a special interest in advanced diabetes care worked with an endocrinologist and diabetes nurse educator to care for referred patients. The main outcome was incremental cost saving per patient course of treatment from a health system perspective. Uncertainty was characterised with probabilistic sensitivity analysis using Monte Carlo simulation. Results: The Beacon model is cost saving: The incremental cost saving per patient was A$365 (95% confidence interval-A$901, A$55) and was cost saving in 93.7% of simulations. The key contributors to the variance in the cost saving per patient course of treatment were the mean number of patients seen per site and the number of additional presentations per course of treatment associated with the Beacon model. Conclusions: Beacon clinics were less costly per patient course of treatment than usual care in hospital OPDs for equivalent clinical outcomes. Local contractual arrangements and potential variation in the operational cost structure are of significant consideration in determining the cost-efficiency of Beacon models. What is known about this topic?: Despite the growing importance of achieving care quality within constrained budgets, there are few costing studies comparing clinically-equivalent hospital and community-based care models. What does this paper add?: Costing analyses comparing hospital-based to GP-based health services require considerable effort and are complex. We show that GP-based Beacon clinics for patients with complex chronic disease can be less costly per patient course of treatment than usual care offered in hospital OPDs. What are the implications for practitioners?: In addition to improving access and convenience for patients, transferring care from hospital to the community can reduce health system costs.
UR - https://www.scopus.com/pages/publications/85097409301
U2 - 10.1071/AH19226
DO - 10.1071/AH19226
M3 - Article
C2 - 33563370
AN - SCOPUS:85097409301
SN - 0156-5788
VL - 45
SP - 42
EP - 50
JO - Australian Health Review
JF - Australian Health Review
IS - 1
ER -
