International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026
Diabetes care guided by quality indicators: a cost-effectiveness analysis in the Brazilian public health system.
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de Castro Alves Yasmin Vitória Andrade, de Oliveira Márcio Galvão, Pereira Leonardo Régis Leira, Oliveira Lara de Souza, de Castro Priscila Ribeiro, Aguiar Erlan Canguçu, Moreira Pablo Maciel Brasil, Mistro Sóstenes
Аннотация
BACKGROUND: Diabetes mellitus (DM) is one of the most common non-communicable diseases worldwide and is associated with a substantial increase in the healthcare burden due to high rates of morbidity, mortality, and long-term complications. Evidence on the economic impact of quality of care for diabetes management based on structured assessment indicators in real-world primary care settings is scarce. This study aimed to evaluate the cost-effectiveness of providing qualified care to individuals with diabetes in primary healthcare settings based on quality-of-care indicators.
METHODS: A cost-effectiveness analysis was conducted using a Markov based model from the perspective of a municipal health manager in Brazil. Data were collected from 114 patients aged 60 years or older with type 2 diabetes mellitus in Vitória da Conquista. Patients were grouped based on whether 15 or more structured quality-of-care indicators were assessed during follow-up visits. The model simulated health state transitions over a 10-year time horizon, incorporating probabilities of complications, quality-adjusted life years, and direct costs. Sensitivity and probabilistic analyses were performed to test model robustness.
RESULTS: Data mining techniques were used to identify a stronger association between the assessed items and a lower probability of having complications. It was found that in the group with 15 or more items assessed during visits, 17.4% had complications, and in the group with fewer than 15 items assessed during visits, this percentage was 37.14%. Therefore, these groups were used as comparators in the economic model. The cost-effectiveness analysis showed that the most comprehensive assessment was the dominant strategy, with an incremental cost-effectiveness ratio of -US$9742.51. The factors that most influenced the model were quality-adjusted life years, the probability of experiencing complications, and the cost of diabetes.
CONCLUSION: Qualified care with a comprehensive approach during follow-up visits was shown to be a cost-effective strategy for improving the quality of life for people with DM.
METHODS: A cost-effectiveness analysis was conducted using a Markov based model from the perspective of a municipal health manager in Brazil. Data were collected from 114 patients aged 60 years or older with type 2 diabetes mellitus in Vitória da Conquista. Patients were grouped based on whether 15 or more structured quality-of-care indicators were assessed during follow-up visits. The model simulated health state transitions over a 10-year time horizon, incorporating probabilities of complications, quality-adjusted life years, and direct costs. Sensitivity and probabilistic analyses were performed to test model robustness.
RESULTS: Data mining techniques were used to identify a stronger association between the assessed items and a lower probability of having complications. It was found that in the group with 15 or more items assessed during visits, 17.4% had complications, and in the group with fewer than 15 items assessed during visits, this percentage was 37.14%. Therefore, these groups were used as comparators in the economic model. The cost-effectiveness analysis showed that the most comprehensive assessment was the dominant strategy, with an incremental cost-effectiveness ratio of -US$9742.51. The factors that most influenced the model were quality-adjusted life years, the probability of experiencing complications, and the cost of diabetes.
CONCLUSION: Qualified care with a comprehensive approach during follow-up visits was shown to be a cost-effective strategy for improving the quality of life for people with DM.