Cost-Effectiveness of Reorganizing the Approach to Diabetes Through the Application of Registries: An Innovative Model to Organize Diabetes Care in First Nations Communities in Canada.

OBJECTIVES

The Reorganizing the Approach to Diabetes through the Application of Registries (RADAR) is an innovative care model incorporating a disease registry and electronic health record tailored for First Nations people in Alberta, Canada. Given its success in improving health outcomes, this study evaluates RADAR's cost-effectiveness compared with standard diabetes care in First Nations populations with type 2 diabetes.

METHODS

The United Kingdom Prospective Diabetes Study Outcomes Model 2 was used to project clinical and cost outcomes over 25 years. Demographics and clinical parameters were used as input parameters. Costs (for RADAR and complications) and utility estimates were derived from the literature. Outcome measures included life-years, quality-adjusted life-years (QALY's), and total and complication costs. Base-case analysis was conducted for eligible patients with type 2 diabetes ≥ 18 years using a Canadian payer perspective with a 25-year time horizon. Future costs and effects were discounted at 3% annually.

RESULTS

RADAR clients experienced higher QALYs (12.69 vs 12.47) than those receiving baseline care. The total cost for RADAR clients (n = 516) was $3971 more per client compared with baseline care. Over the modeled time horizon, the total discounted costs (client management and complications) were higher for RADAR clients than for those receiving baseline care ($16 165 vs $14 463), yielding an incremental cost-effectiveness ratio of $8105 per QALY for RADAR users relative to baseline.

CONCLUSIONS

Our analyses showed that RADAR is potentially cost-effective if the willingness-to-pay threshold of $50 000 per QALY is considered as per the Canadian Agency for Drugs and Technologies in Health guidelines, supporting its value in First Nations care.