Impact of a diabetes disease management program on quality of care and costs: propensity score-matched real-world data from Switzerland

Objectives Structured treatment programs have been recommended for management of patients with chronic conditions to overcome ill-coordinated care. We aimed to evaluate a disease management program (DMP) for diabetes mellitus patients in Switzerland. Methods We performed a prospective observational study with a propensity score-matched usual care control group from a claims database. We included type-1 and type-2 diabetes patients from a primary care setting. The DMP (intervention) comprised a structured treatment approach with an individual treatment plan, treatment goals and an interprofessional team approach. Our outcome comprehensive measures included quality of life (QOL: EQ-5D-5L), pre-defined indicators for diabetes guideline adherence, number of used services and direct medical costs. We applied a difference-in-difference (DID) approach to compare DMP with usual care (follow-up 1 year). Costs were calculated with non-parametric bootstrapping (2017 Swiss Francs, CHF; conversion rate to Euros: 0.85) from a third-party payer perspective (Swiss health care insurance). Results QOL in a sub-sample of 80 patients did not change during follow-up (mean utility 0.89 at baseline and follow-up; p=0.94). Guideline adherence showed slight improvements for DMP. For example, “non-adherence” (baseline DMP: 19%) decreased in the DMP group by −3 %-points (DID; 95%-CI: −0.07 to 0.01) but not in the control group. A general trend emerged, though mostly not statistically significant, with less used services in the DMP group compared to the control group. Costs increased in both groups during follow-up, but the increase was higher in the control group (DID, mean total costs per patient per year: CHF −950.00 [95%-CI: −1959.53 to 59.56]). Such a negative difference-in-difference estimate in favor of DMP also emerged for cost sub-categories (e.g. costs for inpatient and outpatient care). Conclusions The structured treatment program under evaluation is a promising approach to improve diabetes care in a Swiss primary care setting but more follow-up data are needed. ### Competing Interest Statement Competing interests: KE, MC, MH report grants from SWICA Health Care Organisation, Switzerland, during the conduct of the study; KE and MH also report grants from Swiss Accident Insurance (SUVA), grants from AO Foundation, grants from Swiss Federal Office of Public Health, outside the submitted work; KE also reports grants from Astellas, grants from AstraZeneca, grants from Celgene, grants from Janssen-Cilag, grants from Novartis, grants from Amgen, outside the submitted work; BR, MT, CF are employed by SWICA Health Care Organisation, Switzerland; CC and AR are employed by Medbase health care provider, Switzerland; AR is also employed by Institute of Primary Health Care (BIHAM), University of Bern, Switzerland; SWICA Health Care Organization holds shares of Medbase health care provider. ### Clinical Trial The study was not registered as we compared observational data with claims data. ### Funding Statement Funding: The study was in part financially supported by SWICA Health Care Organization, Switzerland. Funding was paid to the Winterthur Institute of Health Economics Institute at Zurich University of Applied Sciences. The funding body commented on the final draft of the manuscript but did not make final decisions regarding the design of the study, the data collection, the analysis and the interpretation of results. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was not required according to the local Ethics committee (decision of Kantonale Ethikkommission Zurich, Switzerland, on our formal request: BASEC-Nr. Req-2017-00416). Our evaluation does not fall under the Human Research Act in Switzerland as it is solely a quality control evaluation for institution-internal purposes. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The health insurance claims data as used for our analysis are stored at Swica Health Organisation, Switzerland. Any questions concerning these data should be directed to MT. Data for QOL and SGED score are stored at Winterthur Institute of Health Economics. Any questions concerning these data should be directed to MC. * CG : Control group CHF : Swiss francs CI : Confidence intervall DM : Diabetes mellitus DMP : Disease Management Program IG : Intervention group OKP : Obligatorische Kranken-und Pflegeversicherung (Basic health insurance in Switzerland) PCG : Pharmaceutical cost groups PROM : Patient-reported outcome measure QOL : Quality of life SD : Standard deviation SGED : Schweizerische Gesellschaft für Endokrinologie und Diabetes (Swiss Society for Endocrinology and Diabetes) VAS : Visual analogue scale 4SPM : 4 simple performance measures (HbA1c; lipid profile; nephropathy examination; ophthalmologic examination)