A study published in Health Policy found that cost and quality are higher among hospital-monitored patients with moderate severity type 2 diabetes.
Researchers assessed the annual healthcare cost of 152,632 general practice and 21,359 hospital-monitored patients with type 2 diabetes. Cost and quality impacts of treatment setting were assessed using an instrumental variable (IV) analysis. A wide range of patient confounders were used to reduce selection bias, with the difference in patients’ travel time between nearest specialist outpatient clinic and GP used as an instrument to control for remaining endogeneity of treatment setting, the researchers noted.
The results showed the average annual healthcare costs were considerably higher amongst hospital-monitored patients. IV analysis accounting for endogeneity of treatment setting indicates hospital-based monitoring is causally linked to higher total annual healthcare costs, the researchers noted. They estimated that local average treatment effect of hospital-based monitoring on total annual healthcare costs was appreciably higher than GP-based monitoring.
“For patients with moderate disease severity type 2 diabetes, IV analysis accounting for treatment setting endogeneity bias identifies an expected efficiency improvement (average cost reduction without reduction of quality) of moving regular disease management from hospital-based setting to the GP setting,” the researchers concluded.
Keywords: Administrative data, Cost, Disease management, Quality of care, Type 2 diabetes