Elsevier

Health Policy

Volume 101, Issue 2, July 2011, Pages 105-121
Health Policy

Review
Impact 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

https://doi.org/10.1016/j.healthpol.2011.03.006Get rights and content

Abstract

Objective

Evaluating the impact of disease management programs on healthcare expenditures for patients with diabetes, depression, heart failure or COPD.

Methods

Systematic Pubmed search for studies reporting the impact of disease management programs on healthcare expenditures. Included were studies that contained two or more components of Wagner's chronic care model and were published between January 2007 and December 2009.

Results

Thirty-one papers were selected, describing disease management programs for patients with diabetes (n = 14), depression (n = 4), heart failure (n = 8), and COPD (n = 5). Twenty-one studies reported incremental healthcare costs per patient per year, of which 13 showed cost-savings. Incremental costs ranged between −$16,996 and $3305 per patient per year. Substantial variation was found between studies in terms of study design, number and combination of components of disease management programs, interventions within components, and characteristics of economic evaluations.

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.

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.

References (71)

  • S. Greß et al.

    Co-ordination and management of chronic conditions in Europe: the role of primary care—position paper of the European forum for primary care

    Quality in Primary Care

    (2009)
  • S. Mattke et al.

    Evidence for the effect of disease management: is $1 billion a year a good investment?

    American Journal of Managed Care

    (2007)
  • D. Singh

    How can chronic disease management programmes operate across care settings and providers?

    (2008)
  • S.G. Adams et al.

    Systematic review of the chronic care model in chronic obstructive pulmonary disease prevention and management

    Archives of Internal Medicine

    (2007)
  • L.M. Steuten et al.

    A disease management programme for patients with diabetes mellitus is associated with improved quality of care within existing budgets

    Diabetic Medicine

    (2007)
  • I. Peytremann-Bridevaux et al.

    Effectiveness of chronic obstructive pulmonary disease-management programs: systematic review and meta-analysis

    The American Journal of Medicine

    (2008)
  • J.B. Hamner

    State of the science: posthospitalization nursing interventions in congestive heart failure

    Advances in Nursing Science

    (2005)
  • C.O. Phillips et al.

    Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis

    Journal of American Medical Association

    (2004)
  • E. Seto

    Cost comparison between telemonitoring and usual care of heart failure: a systematic review

    Telemedicine Journal and e-Health

    (2008)
  • R.Z. Goetzel et al.

    Return on investment in disease management: a review

    Health Care Financing Review

    (2005)
  • S.A. Boren et al.

    Costs and benefits associated with diabetes education: a review of the literature

    The Diabetes Educator

    (2009)
  • P. Urbanski et al.

    Cost-effectiveness of diabetes education

    Journal of America Dietetic Association

    (2008)
  • F. Verhoeven et al.

    The contribution of teleconsultation and videoconferencing to diabetes care: a systematic literature review

    Journal of Medical Internet Research

    (2007)
  • D.P. Wubben et al.

    Effects of pharmacist outpatient interventions on adults with diabetes mellitus: a systematic review

    Pharmacotherapy

    (2008)
  • J. Sidorov et al.

    Does diabetes disease management save money and improve outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization-sponsored disease management program among patients fulfilling health employer data and information set criteria

    Diabetes Care

    (2002)
  • P.D. Griffiths et al.

    Effectiveness of intermediate care in nursing-led in-patient units

    Cochrane Database of Systematic Reviews

    (2007)
  • S. Gilbody et al.

    Costs and consequences of enhanced primary care for depression: systematic review of randomised economic evaluations

    British Journal of Psychiatry

    (2006)
  • L.M. Steuten et al.

    Identifying potentially cost effective chronic care programs for people with COPD

    International Journal of Chronic Obstructive Pulmonary Disease

    (2009)
  • A.M. Gommer et al.

    Welke ziekten hebben de hoogste prevalentie?

    Volksgezondheid Toekomst Verkenning, Nationaal Kompas Volksgezondheid

    (2010)
  • E.H. Wagner et al.

    Improving chronic illness care: translating evidence into action

    Health Affairs (Millwood)

    (2001)
  • E.H. Wagner et al.

    Finding common ground: patient-centeredness and evidence-based chronic illness care

    Journal of Alternative and Complementary Medicine

    (2005)
  • E.H. Wagner

    The role of patient care teams in chronic disease management

    British Medical Journal

    (2000)
  • Organisation for Economic Co-operation and Development

    OECD Health Data 2009

    (2009)
  • D.E. Clancy et al.

    Do diabetes group visits lead to lower medical care charges?

    American Journal of Managed Care

    (2008)
  • D. Del Sindaco et al.

    Two-year outcome of a prospective, controlled study of a disease management programme for elderly patients with heart failure

    Journal of Cardiovascular Medicine (Hagerstown)

    (2007)
  • Cited by (0)

    View full text