J Clin Outcomes Manage
A proposal for a new measure to assess efficiency of diabetes care
Pogach LM, Aron DC
Abstract Objective: To propose a conceptual framework for efficiency assessment in diabetes treatment based on the absolute population benefit obtained for the pharmaceutical costs of risk factor management. Methods: Descriptive report. Results: The risks and benefits of risk factor control differ substantially based on diabetes duration, life expectancy, and comorbid conditions. Additionally, the specific medications used to achieve control differ in efficacy, side effects, and costs. Therefore, current individual threshold and proposed composite all-or-none performance measures are not consistent with the clinical epidemiology of disease (eg, absolute risk reduction is continuous). Consequently, the use of such measures is not appropriate to assess value since the marginal quality and cost (efficiency) of incremental improvement cannot be ascertained. Additionally, presenting aggregate results may mask over- or undertreatment in specific subpopulations. We propose a new paradigm for assessing pharmaceutical efficiency using quality-adjusted life years, calculated separately within multiple age/risk categories, as the output (numerator) and acquisition costs of medications as the input (denominator). Conclusion: Assessment of efficiency in the treatment of glucose, blood pressure, and cholesterol in persons with diabetes should incorporate evaluation of the future health care benefit that is “purchased” by direct pharmaceutical costs. This will require para-digm shifts in conceptualizing quality measures as being continuous rather than dichotomous and evaluating benefit in multiple populations that may differ by age and comorbid conditions.
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