A cost-effectiveness analysis of group care in type 2 and type 1 diabetes

Different of economic analyses are sometimes delivered to compare different health procedures. In this chapter we apply a cost-effectiveness analysis to a validated Group Care approach for diabetic patients, as compared with traditional, individually delivered care and education. Working on a differential basis, differential (and greater) costs associated with Group Care are opposed to its differential (and better) outcomes. Costs comprise differential direct costs, either paid by the Italian National Health System (mainly staff costs) or by patients (transportation and opportunity costs of time allocated to the two procedures). As the main endpoint in either case (a 4-year follow-up for type 2 with 90 patients, and a 3-year follow-up for type 1, with 62 patients, in both cases randomly assigned to the two competing procedures), we chose differrential scores in perceived quality of life, which proved meaningful and statistically robust. Resulting cost-effectiveness ratios are EUR 2.28 per point in the DQOL score for type 2 diabetes, and EUR 19.46 for patients with type 1. This was in both cases a very reasonable additional burden that – from a societal point of view – makes future extensions of Group Care very attractive. The robustedness of the results are discussed and tested in sensitivity analyses, run by changing the end-points and/or cost composition.