Real-World Cost-Consequence Analysis of an Integrated Chronic Disease Management Program in Saskatchewan, Canada.

Autor:	Kuwornu JP; Research Department, Saskatchewan Health Authority, Regina, SK, Canada., Maldonado F; Health Quality Council, Saskatoon, SK, Canada., Groot G; Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada., Penz E; Respirology, Critical Care & Sleep Medicine, The Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada., Cooper EJ; Kinesiology and Health Studies, University of Regina, Regina, SK, Canada., Reid A; Clinical Integration Unit, Saskatchewan Health Authority, Regina, SK, Canada., Marciniuk DD; Kinesiology and Health Studies, University of Regina, Regina, SK, Canada.
Jazyk:	angličtina
Zdroj:	Health services insights [Health Serv Insights] 2024 Jan 10; Vol. 17, pp. 11786329231224621. Date of Electronic Publication: 2024 Jan 10 (Print Publication: 2024).
DOI:	10.1177/11786329231224621
Abstrakt:	An integrated disease management program otherwise called a clinical pathway was recently implemented in Saskatchewan, Canada for patients living with chronic obstructive pulmonary disease (COPD). This study compared the real-world costs and consequences of the COPD clinical pathway program with 2 control treatment programs. The study comprised adult COPD patients in Regina (clinical pathway group, N = 759) matched on propensity scores to 2 independent control groups of similar adults in (1) Regina (historical controls, N = 759) and (2) Saskatoon (contemporaneous controls, N = 759). The study measures included patient-level healthcare costs and acute COPD exacerbation outcomes, both tracked in population-based administrative health data over a one-year follow-up period. Analyses included Cox proportional hazards models and differences in means between groups. The bias-corrected and accelerated bootstrap method was used to calculate 95% confidence intervals (CI). The COPD pathway patients had lower risks of moderate (hazard ratio [HR] =0.57, 95% CI [0.40-0.83]) and severe (HR = 0.43, 95% CI [0.28-0.66]) exacerbations compared to the historical control group, but similar risks compared with the contemporaneous control group. The COPD pathway patients experienced fewer episodes of exacerbations compared with the historical control group (mean difference = -0.30, 95% CI [-0.40, -0.20]) and the contemporaneous control group (mean difference = -0.12, 95% CI [-0.20, -0.03]). Average annual healthcare costs in Canadian dollars were marginally higher among patients in the COPD clinical pathway (mean = $10 549, standard deviation [SD] =$18 149) than those in the contemporaneous control group ($8841, SD = $17 120), but comparable to the historical control group ($10 677, SD = $21 201). The COPD pathway provides better outcomes at about the same costs when compared to the historical controls, but only slightly better outcomes and at a marginally higher cost when compared to the contemporaneous controls. Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Marciniuk has undertaken consulting with Alberta Health Services, Health Canada, Ontario Ministry of Health and Long-Term Care, Saskatchewan Health Authority, and Yukon Health and Social Services. He has provided research advisory and received research funding (managed and held by University of Saskatchewan) from AstraZeneca, Boehringer Ingelheim, Canadian Institutes of Health Research, GlaxoSmithKline, Grifols, Lung Saskatchewan, Novartis, Sanofi, Saskatchewan Health Research Foundation, and Schering-Plough. Dr. Marciniuk is an employee of the University of Saskatchewan, is a Board Member of the Saskatchewan Health Research Foundation and serves as Deputy Editor, CHEST Journal. Dr. Penz reports grants from Saskatchewan Health Research Foundation SPROUT grant, during the conduct of the study; grants and personal fees from Astra Zeneca, grants and personal fees from GlaxoSmithKline, grants and personal fees from Sanofi, personal fees from COVIS Pharma, personal fees from Boehringer Ingelheim, outside the submitted work; and she is the Co-Chair of the Canadian Thoracic Society COPD Assembly. She is the Co-Chair of the ACTonCOPD National Steering Committee. All other authors have no conflicts to disclose. (© The Author(s) 2024.)
Databáze:	MEDLINE
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