Improving quality of care in people with Type 2 diabetes through the Associazione Medici Diabetologi‐annals initiative: a long‐term cost‐effectiveness analysis

Aims The Associazione Medici Diabetologi‐annals initiative is a physician‐led quality‐of‐care improvement scheme that has been shown to improve HbA 1c concentration, blood pressure, lipid profiles and BMI in enrolled people with Type 2 diabetes. The present analysis investigated the long‐term cost‐effectiveness of enrolling people with Type 2 diabetes in the Associazione Medici Diabetologi‐annals initiative compared with conventional management. Methods Long‐term projections of clinical outcomes and direct costs (in 2010 Euros) were made using a published and validated model of Type 2 diabetes in people with Type 2 diabetes who were either enrolled in the Associazione Medici Diabetologi‐annals initiative or who were receiving conventional management. Treatment effects were based on mean changes from baseline seen at 5 years after enrolment in the scheme. Costs and clinical outcomes were discounted at 3% per annum. Results The Associazione Medici Diabetologi‐annals initiative was associated with improvements in mean discounted life expectancy and quality‐adjusted life expectancy of 0.55 years (95% CI 0.54–0.57) years and 0.48 quality‐adjusted life years (95% CI 0.46–0.49), respectively, compared with conventional management. Whilst treatment costs were higher in the Associazione Medici Diabetologi‐annals arm, this was offset by savings as a result of the reduced incidence and treatment of diabetes‐related complications. The Associazione Medici Diabetologi‐annals initiative was found to be cost‐saving over patient lifetimes compared with conventional management [€ 37,289 (95% CI 37,205–37,372) vs € 41,075 (95% CI 40,956–41,155)]. Conclusions Long‐term projections indicate that the physician‐led Associazione Medici Diabetologi‐annals initiative represents a cost‐saving method of improving long‐term clinical outcomes compared with conventional management of people with Type 2 diabetes in Italy.