Are Disease managment Programs effective or too costly- review of recent research

A review of current peer reviewed research or research presented by professional organizations with peer reviewed journals reveals that Disease Management programs are not cost effective for direct costs without inclusion of indirect costs, societal costs. In addition Programs that are effective are long term, and targeted to selected populations.
In effect Insurance companies who must manage a broad scope of health care costs and over a long period of time may benefit from disease management programs for targeted patients. Firms that are out sourcing these models, will find reactive disease management programs too expensive. But other research indicates that proactive programs for health coaching are on the increase and profitable in 2008.

Nov. 9, 2004 (New Orleans) — Disease management improves survival in patients with congestive heart failure (CHF), especially in those with advanced disease. But the program does not save healthcare utilization or costs, according to results of a late-breaking clinical trial presented here at the American Heart Association 2004 Scientific Sessions.
"Disease management promised a lot but those promises may be empty," lead investigator Autumn Dawn Galbreath, MD, vice chairman for clinical programs in the Department of Medicine at the University of Texas in San Antonio, said when presenting the results at an early morning press conference. The formal results were presented at the meeting by coinvestigator Gregory I. Freeman, MD, from the University of Texas Health Science Center in San Antonio.
The investigators randomized 1,069 community-based patients with CHF to receive disease management or usual care. Average age of the group was 70.9 years. All had systolic heart failure with ejection fractions averaging 35% or echo-confirmed diastolic heart failure. Patients were followed for 18 months, with investigators conducting assessments of clinical status by telephone at six-month intervals.
http://www.medscape.com/viewarticle/582790


October 29, 2008 (Philadelphia, PA) — A heart-failure disease-management program that had cut the risk of hospitalization in a predominantly Hispanic and black population [1] is also cost-effective in that the benefit came at an expected societal cost under $25 000 per quality-adjusted life-year (QALY) gained
In the current analysis, the nurse-led intervention cost an average of $2177 per patient but reduced hospital costs by $2378 per patient; however, "higher costs for outpatient procedures, medications, and home healthcare prevented the intervention from being cost-saving over the 12-month study," according to the authors.
The incremental cost per QALY gained for the intervention program was estimated at $19 691 or $21 470, depending on the quality-of-life instrument used, either the Health Utility Index Mark 3 or EuroQol-5D, respectively, after adjustment for baseline quality-of-life differences between groups.
The estimated net 12-month cost to Medicare associated with implementation of the disease-management program was either $3176 or $3673 per QALY, respectively.
The study's results are consistent with an ongoing Medicare demonstration product, according to Hebert et al, that "found no evidence that [its] nurse-management interventions were cost-saving or cost-neutral.

http://www.medscape.com/viewarticle/582790


The economic effectiveness of disease management programs, which are designed to improve the clinical and economic outcomes for chronically ill individuals, has been evaluated extensively. A literature search was performed with MEDLINE and other published sources for the period covering January 1995 to September 2003. The search was limited to empirical articles that measured the direct economic outcomes for asthma, diabetes, and heart disease management programs. Of the 360 articles and presentations evaluated, only 67 met the selection criteria for meta-analysis, which included 32,041 subjects. Based on the studies included in the research, a meta-analysis provided a statistically significant answer to the question of whether disease management programs are economically effective. The magnitude of the observed average effect size for equally weighted studies was 0.311 (95% CI = 0.272-0.350).

The results suggest that disease management programs are more effective economically with severely ill enrollees and that chronic disease program interventions are most effective when coordinated with the overall level of disease severity.

http://www.citeulike.org/user/waffle168/article/197597

Heart failure (HF) disease management programs have shown impressive reductions in hospitalizations and mortality, but in studies limited to short time frames and high-risk patient populations. Current guidelines thus only recommend disease management targeted to high-risk patients with HF.
METHODS: This study applied a new technique to infer the degree to which clinical trials have targeted patients by risk based on observed rates of hospitalization and death. A Markov model was used to assess the incremental life expectancy and cost of providing disease management for high-risk to low-risk patients. Sensitivity analyses of various long-term scenarios and of reduced effectiveness in low-risk patients were also considered. RESULTS: The incremental cost-effectiveness ratio of extending coverage to all patients was $9700 per life-year gained in the base case. In aggregate, universal coverage almost quadrupled life-years saved as compared to coverage of only the highest quintile of risk. A worst case analysis with simultaneous conservative assumptions yielded an incremental cost-effectiveness ratio of $110,000 per life-year gained. In a probabilistic sensitivity analysis, 99.74% of possible incremental cost-effectiveness ratios were <$50,000 per life-year gained. CONCLUSIONS: Heart failure disease management programs are likely cost-effective in the long-term along the whole spectrum of patient
risk. Health gains could be extended by enrolling a broader group of patients with HF in disease management.

http://www.ncbi.nlm.nih.gov/pubmed/18215605
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