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Health economics
Research
Patient level cost of diabetes self-management education programmes: an international evaluation
  1. Gerardine Doyle1,
  2. Shane O'Donnell1,
  3. Etáin Quigley1,
  4. Kate Cullen1,
  5. Sarah Gibney1,
  6. Diane Levin-Zamir2,
  7. Kristin Ganahl3,
  8. Gabriele Müller4,
  9. Ingrid Muller5,
  10. Helle Terkildsen Maindal6,
  11. Wushou Peter Chang7,8,
  12. Stephan Van Den Broucke9
  1. 1University College Dublin, , Dublin, , Ireland
  2. 2Clalit Health Services, , Tel-Aviv, , Israel
  3. 3Gesundheit Osterreich GmbH, , Vienna, , Austria
  4. 4Technische Universitat Dresden, , Dresden, , Sachsen, , Germany
  5. 5Department of Psychology, University of Southampton, , Southampton, , UK
  6. 6Aarhus University, , Aarhus, , Denmark
  7. 7School of Public Health, Taipei Medical University, , Taipei, , Taiwan
  8. 8Department of Occupational Medicine, Shuang Ho and Taipei Medical University Hospital, , Taipei, , Taiwan
  9. 9Universite catholique de Louvain, Psychological Sciences Research Institute, , Louvain, , Belgium
  1. Correspondence to ; gerardine.doyle{at}ucd.ie

Abstract

Objectives The objective of this study was to examine the value of time-driven activity-based costing (TDABC) in understanding the process and costs of delivering diabetes self-management education (DSME) programmes in a multicountry comparative study.

Setting Outpatient settings in five European countries (Austria, Denmark, Germany, Ireland, UK) and two countries outside Europe, Taiwan and Israel.

Participants Providers of DSME programmes across participating countries (N=16) including healthcare professionals, administrators and patients taking part in DSME programmes.

Primary and secondary measures Primary measure: time spent by providers in the delivery of DSME and resources consumed in order to compute programme costs. Secondary measures: self-report measures of behavioural self-management and diabetes disease/health-related outcomes.

Results We found significant variation in costs and the processes of how DSME programmes are provided across and within countries. Variations in costs were driven by a combination of price variances, mix of personnel skill and efficiency variances. Higher cost programmes were not found to have achieved better relative outcomes. The findings highlight the value of TDABC in calculating a patient level cost and potential of the methodology to identify process improvements in guiding the optimal allocation of scarce resources in diabetes care, in particular for DSME that is often underfunded.

Conclusions This study is the first to measure programme costs using estimates of the actual resources used to educate patients about managing their medical condition and is the first study to map such costs to self-reported behavioural and disease outcomes. The results of this study will inform clinicians, managers and policy makers seeking to enhance the delivery of DSME programmes. The findings highlight the benefits of adopting a TDABC approach to understanding the drivers of the cost of DSME programmes in a multicountry study to reveal opportunities to bend the cost curve for DSME.

  • Self-management
  • Cost
  • Health literacy
  • Time-driven activity based costing

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2016-013805

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    Footnotes

    • Contributors GD initially proposed the study. GD and SG specified the methodology. GD and KC carried out the cost analysis. All authors contributed to the protocol design, data collection and analysis plan. EQ and SOD wrote the initial manuscript, and all authors contributed to improving the manuscript. All authors approved the final manuscript.

    • Funding This study is part of the Diabetes Literacy project supported by grant FP7-Health-2012-Innovation 1/306186 of the European Commission.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval All methods were approved by the SVUH Group Research and Ethics Committee, by the Research Ethics Committee of the Office of Research Ethics, University College Dublin, and by the relevant local ethics committee in each jurisdiction and each study site where the study was carried out.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The Excel spreadsheets showing how the individual activity costs were aggregated are available should they be requested.

    • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.