Diabetes education lowers health care costs, improves health care utilization
Click Here to Manage Email Alerts
Diabetes self-management education and support interventions might help reduce health care costs and improve utilization, but evidence varies across studies, according to findings from a systematic review.
“Diabetes self-management education and support (DSMES) interventions may positively impact economic and health care utilization outcomes — meaning costs related to inpatient admissions, emergency department utilization and total costs of care tended to be lower for people with diabetes who received DSMES services than individuals who did not,” Andrew S. Bzowyckyj, PharmD, BCPS, CDCES, associate professor of pharmacy practice at Pacific University Oregon School of Pharmacy and clinic pharmacist at Legacy Medical Group, told Healio. “Unfortunately, a consistent pattern was not observed across all of the studies, so we cannot make any definitive assertions, but the general trajectory of the data points toward positively favoring DSMES from an economic overall cost of care perspective.”
Bzowyckyj and colleagues conducted a systematic review of studies on economic and health utilization outcomes following DSMES interventions in the U.S. published from 2006 to May 5, 2020. All interventions had at least one element of the ADCES7 Self-Care Behaviors from the Association of Diabetes Care & Education Specialists (ADCES). Economic costs and health care utilization outcomes were extracted from each study. Total costs were defined using each article’s definition of total cost; other costs and utilization included outpatient care, pharmacy costs, physician visits, medical claims and medication or supply costs; inpatient utilization included hospital utilization, hospital days, readmission, hospitalization rates and inpatient costs; and ED utilization included visits, costs or utilization rates for the ED.
The findings were published in The Science of Diabetes Self-Management and Care.
There were 22 articles included in the review with a total of 655,605 participants. There were eight quasi-experimental studies, seven randomized controlled trials, five cohort studies and one case-control study included. Eleven studies included adults with type 2 diabetes, five included participants with type 1 and type 2 diabetes, and five did not report diabetes type.
Four studies reported a decrease in inpatient utilization or costs, four reported a decrease in outpatient medical costs, three reported a decrease in ED utilization and one reported a decrease in pharmacy claims and costs after DSMES interventions. Outpatient costs increased in one study with a commercially insured cohort, and three studies reported an increase in pharmacy costs. Total costs decreased in four studies and increased in two.
Fourteen studies included all seven components of the ADCES7 Self-Care Behaviors. Of those 14 studies, seven reported decreases in costs and utilization, one reported an increase in costs and utilization, and associations were unclear in six.
Bzowyckyj said there were several reasons the studies had a large amount of heterogeneity, including the variety of intervention types, the diverse patient populations, availability of data, varying durations of the interventions, and differences in which economic outcomes were measured. He said those variables make it imperative for further studies to be conducted.
“As the U.S. health care system continues to shift away from strictly fee-for-service models and more toward value-based programs, it is imperative to conduct formal health economic analyses to evaluate the impact of DSMES on all aspects of the quadruple aim —lower cost, better health, improved patient satisfaction and improved provider satisfaction,” Bzowyckyj said. “These studies should clearly include the details of their specific DSMES intervention, including how each ADCES7 component was addressed.”
Bzowyckyj added that research teams should include a diabetes care and education specialist to improve the utility of the studies.
For more information:
Andrew S. Bzowyckyj, PharmD, BCPS, CDCES, can be reached at bzowyckyj@pacificu.edu.
Perspective
Back to Top
Jan Kavookjian, PhD, MBA, FAPhA, FADCES
There is a paucity of studies examining economic outcomes from diabetes self-management education and support (DSMES), so the retaining of 22 studies in this well-conducted systematic review brings forth a solid body of work. It is often challenging for scholars to gain access to actual cost data, so it is not surprising that many of these retained studies did what most others do and used the cost proxy variables of medical services and medication utilization to serve as indicators of expense.
It is not surprising that methods and measures are heterogeneous among retained studies in the review, but even so, the science behind the studies, and the search and review tiers applied in this review, suggest that there is promise in at least half of the retained studies for DSMES impact on economic outcomes.
This review also includes studies that are not randomized controlled trials, but rather well-conducted studies of other rigorous designs. These are very informative to settings like those where randomized controlled trials are not the norm or are not feasible; much can be learned and disseminated from studies in relatable settings. It is also not a surprise that some studies showed increases in costs — often a successful intervention means that persons will respond to an intervention with increased utilization for care (medical visits) and medications, which translates to increased cost.
It is important to remember that increased utilization, even with higher costs during the study timeline, is a desired outcome, with the long-range assumption that receiving needed care and taking medications according to the prescription suggests that long-term economic outcomes from complications prevented should be less. As is often the practical case in outcomes research, many of the studies in this review did not use long enough duration to see the long-term cost benefits from increased medical care and medication taken during the study timeline.
Collapse
Click Here to Manage Email Alerts