Cost effectiveness of a simulated physician learning program to improve glucose control in adults with diabetes
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Background and Objective: Individualized simulated learning interventions completed by primary care providers have resulted in improved blood sugars for patients with suboptimal glucose control. The aim of this study is to assess the cost-effectiveness of the simulated learning intervention.
Methods: Clinical outcome and cost data from a randomized clinical trial of simulated physician learning intervention were used as inputs into a validated simulation model of diabetes (the UKPDS Outcomes Model) to evaluate remaining life years, quality adjusted life years (QALYs), and health care costs over patient lifetimes (40-year time horizon) from the health system perspective. The simulation cohort included 1,403 patients with diabetes with glycosylated hemoglobin (A1c) >7% at baseline. Costs of diabetes related complications were estimated from the cost accounting system of a large health plan.
Findings: Patients in the intervention group had significantly lower A1c (-.19%, P=.034) relative to patients in the control arm. Intervention costs were $35 per patient in the first year and $14 per patient in the following years. In the base case analysis, the simulated learning intervention increased lifetime QALYs by 0.02 and reduced lifetime costs by $489. The cost-effectiveness of the intervention persisted in one-way, two-way, and probabilistic sensitivity analyses.
Conclusions: A simulated diabetes training program completed by primary providers in a large medical group was associated with increased quality of life and reduced costs. Dissemination of the simulated learning technology to other provider settings warrants consideration.