Applying a private sector capitation model to the management of type 2 diabetes in the South African public sector: a cost-effectiveness analysis

BMC Health Services Research

Karen J Hofman²  Alisha N Wade²  Ruxana Jina¹  Melanie Y Bertram²  Heinrich C Volmink³ 

[1]Gauteng Department of Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa

[2]School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

[3]Department of Community Health of the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

关键词: National health insurance;    Diabetes mellitus;    Cost-effectiveness;    Capitation;   

Others  :  1126077
DOI  :  10.1186/1472-6963-14-444

 received in 2013-09-18, accepted in 2014-09-18,  发布年份 2014

【 摘 要 】

Background

Diabetes mellitus contributes substantially to the non-communicable disease burden in South Africa. The proposed National Health Insurance system provides an opportunity to consider the development of a cost-effective capitation model of care for patients with type 2 diabetes. The objective of the study was to determine the potential cost-effectiveness of adapting a private sector diabetes management programme (DMP) to the South African public sector.

Methods

Cost-effectiveness analysis was undertaken with a public sector model of the DMP as the intervention and a usual practice model as the comparator. Probabilistic modelling was utilized for incremental cost-effectiveness ratio analysis with life years gained selected as the outcome. Secondary data were used to design the model while cost information was obtained from various sources, taking into account public sector billing.

Results

Modelling found an incremental cost-effectiveness ratio (ICER) of ZAR 8 356 (USD 1018) per life year gained (LYG) for the DMP against the usual practice model. This fell substantially below the Willingness-to-Pay threshold with bootstrapping analysis. Furthermore, a national implementation of the intervention could potentially result in an estimated cumulative gain of 96 997 years of life (95% CI 71 073 years – 113 994 years).

Conclusions

Probabilistic modelling found the capitation intervention to be cost-effective, with an ICER of ZAR 8 356 (USD 1018) per LYG. Piloting the service within the public sector is recommended as an initial step, as this would provide data for more accurate economic evaluation, and would also allow for qualitative analysis of the programme.

【 授权许可】

   
2014 Volmink et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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