Cost-effectiveness analysis of a pharmacotherapeutic empowerment strategy for patients with type 2 diabetes mellitus

• Published in: BMJ open diabetes research & care Vol. 7; no. 1; p. e000647
• Main Authors: Gonçalves, Ana Carolina Oliveira, Cazarim, Maurílio de Souza, Sanches, Cristina, Pereira, Leonardo Regis Leira, Camargos, Ana Márcia Tomé, Aquino, Jéssica Azevedo, Oliveira Baldoni, Andre
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 2019; BMJ Publishing Group
• Series: Research
• Subjects: Biomarkers - analysis; Blood Glucose - analysis; Case-Control Studies; Clinical Care/Education/Nutrition; Cost analysis; Cost of Illness; Cost-Benefit Analysis; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - economics; Disease management; Drug therapy; Economics, Pharmaceutical; Empowerment; Female; Follow-Up Studies; Glycated Hemoglobin - analysis; Humans; Hypoglycemic Agents - economics; Hypoglycemic Agents - therapeutic use; Intervention; Male; Middle Aged; Non-Randomized Controlled Trials as Topic; Patients; Pharmacists; Pharmacoeconomics; Prognosis; Public health; Quality of Life; Brazil; cost-effectiveness; endocrinology diabetes; pharmacoeconomics; public health
• ISSN: 2052-4897; 2052-4897
• DOI: 10.1136/bmjdrc-2018-000647

BackgroundThe economic feasibility of pharmacotherapeutic empowerment of patients with type 2 diabetes mellitus (DM2) is still not well established.ObjectivesTo evaluate the cost-effectiveness of an individual pharmacotherapeutic empowerment strategy (IPES) for patients with DM2.MethodsThis is a cost-effectiveness study nested in a non-randomized clinical trial with patients ≥18 years of age, of both genders, with low and moderate cardiovascular risks. This study was carried out from the perspective of the municipal health system of Divinópolis in Minas Gerais state, and compared patients submitted to an IPES and patients who received only traditional care, 1 year before the beginning of the intervention (baseline) and 1 year after its completion (follow-up). The costs of the services offered by the municipality were computed, and in the intervention group IPES costs were included. Glycated hemoglobin (A1c) was the effectiveness parameter adopted. Cost-effectiveness ratio analyses, incremental cost-effectiveness ratio (ICER), and sensitivity analysis were performed.ResultsIn the analysis of cost-effectiveness, it is observed that a reduction of 0.359 in A1c costs US$708.47 in the intervention group and a reduction of 0.170 costs US$1927.13 in the control group. Thus, the ICER is US$387.66 per patient/year. In the sensitivity analysis, it was observed that the IPES was dominant in 19.8% of the simulated scenarios and cost-effective in 80.2%.ConclusionsThe IPES is an alternative that presents economic feasibility for the municipal public health system scenario. The absence of randomization in patient selection is a limitation of this study.