ReviewImpact of disease management programs on healthcare expenditures for patients with diabetes, depression, heart failure or chronic obstructive pulmonary disease: A systematic review of the literature
Introduction
Chronic illnesses are the leading cause of disability and death in the western part of the world [1]. Over the coming years, the prevalence of chronic illnesses is predicted to increase as a result of the rapid ageing of the world population and the greater longevity of people with chronic conditions [2], [3]. This trend has major economic consequences for health care systems. In the United States for example, the total yearly healthcare costs for heart disease were estimated at $352 billion [3] and the yearly healthcare costs for diabetes were estimated at $116 billion [4].
Disease management programs are increasingly implemented in healthcare systems worldwide in order to enhance quality and continuity of care for the chronically ill, whilst making efficient use of healthcare resources. In broad terms disease management refers to a patient-centred approach of coordinated multiple healthcare interventions that structure chronic care to a specific patient group [5], [6]. It is also referred to as e.g. integrated care, managed care, patient-centred care, and case management. Although it is generally believed that disease management programs result into improved patient health outcomes and into healthcare cost savings there is a lack of conclusive scientific evidence supporting these suggestions [5], [6], [7].
In terms of health outcomes, disease management programs may be particularly effective for patients with diabetes, heart failure, and depression. Disease management programs for patients with COPD, asthma and coronary artery disease have generally shown similar results as usual care [6], [8], [9], [10]. At the same time disease management programs for COPD and asthma have shown improvements in quality of life [11], [12].
In terms of reducing healthcare costs, disease management programs may be particularly effective for patients with heart failure, as a result of e.g. reduced hospitalization rates and emergency room visits [6], [13], [14], [15], [16], [17]. Evidence is less conclusive for disease management programs for patients with diabetes, coronary artery disease, asthma, COPD, and depression [6], [17], [18], [19], [20], [21]. Steuten et al. [10], Adams et al. [9], and Sidorov et al. [22] found that disease management programs for these chronic diseases lead to a reduction in healthcare costs due to e.g. fewer hospital admissions or fewer emergency room visits, whereas other studies did not find rigorous evidence for notable reductions in such healthcare costs [8], [23], [24], [25].
The objective of the present paper was to review the most recent literature on the economic effects of disease management programs. In recent years, disease management programs have received a more prominent role in healthcare. It is expected that this trend generated more economic evaluations of disease management programs and consequently more evidence regarding its economic effects. This paper focuses on disease management programs for diabetes, depression, heart failure, and chronic obstructive pulmonary disease (COPD) since the prevalence of these chronic diseases is high and disease management programs for these chronic diseases are most widespread [3], [6], [26].
Section snippets
Disease management
For this study the chronic care model (CCM) of Wagner et al. [27], [28] was used to operationalize disease management. The model suggests that disease management ideally comprises six interrelated components. Two components mainly refer to the context where chronic care is provided: 1. healthcare system that is open to optimize chronic care and 2. links towards community resources and policies (e.g. physical activity programs delivered by a local fitness centre). The remaining four components
Study retrieval
Our literature search yielded 231 potentially relevant papers. On the basis of these papers’ title and abstract, 42 papers were selected by the reviewers to be retrieved full-text for in-depth screening. This screening process resulted into 31 papers for inclusion in our study. Reasons for exclusion are given in Fig. 1. Papers were sometimes excluded for more than one reason. In the flowchart only the most relevant reason for exclusion is presented.
Study designs
Out of the 31 studies, 14 focused on diabetes,
Discussion
This systematic literature review presents results of recent evaluations on the economic effects of disease management programs for diabetes, depression, heart failure, and COPD. In more than half of the included studies evaluating incremental healthcare costs, disease management was associated with lower healthcare expenditures. In line with previous reviews [6], [13], [15], [16], [17], [24], [63], [64], also our literature review shows that results may be most positive for disease management
Conclusion
Although it is widely believed that disease management programs reduce healthcare expenditures, the present study shows that evidence for this claim is still inconclusive. Nevertheless disease management programs are increasingly implemented in healthcare systems worldwide. To support well-considered decision-making in this field, well-designed economic evaluations should be stimulated.
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