Cost-Effectiveness of Treatment Strategies for Comorbid Diabetes and Dyslipidemia Part 2

Approaches for Cost Containment and Income Generation in Managing Patients With Diabetes and Dyslipidemia

Patients With Diabetes and Dyslipidemia Respond to Collaborative Care Patient Physician Allied Health Professionals (RNs, RPhs, RDs, psychologists) Patient Family & Peers Good chronic care requires a “prepared, proactive practice team interacting with an informed, activated patient” Bodenheimer T. JAMA. 2007;298(17):

Disease Management Programs Improve HEDIS Measures A1C Uncontrolled A1C Eye Patients, % P= P values controlled for age, sex, presence of pharmacy, enrollment duration, and insurance type. Sidorov J, et al. Diabetes Care. 2002;25(4): Patients not enrolled in program (n=3, 681) Patients enrolled in program (n=3,118) Testing Lipids Renal Screening P=0.0001

Disease Management Programs Reduce Spending in Patients With Diabetes Admissions Days ER Visits Primary Care Office Visits Paid Charges Mean, per member per month, $ Mean, per member Per year P< P=0.026 P=0.003 P=0.128 P=0.001 Monthly Paid Charges Healthcare Utilization P values controlled for age, sex, presence of pharmacy, enrollment duration, and insurance type. Sidorov J, et al. Diabetes Care. 2002;25(4): Patients enrolled in program (n=3,118) Patients not enrolled in program (n=3,681) Inpatient

Encourage Appropriate Lipid Management  Measures are needed to overcome clinical inertia and encourage appropriate and timely LDL-C management  25% of patients not receiving LDL-C lowering therapy had levels higher than recommended threshold for initiation of drug therapy a  30% of treated patients had LDL-C levels above recommended values a Mean (SD) No drug therapyDrug therapy Initial1 YearInitial1 Year Total cholesterol208 (47)210 (49)247 (55)219 (53) LDL-C138 (43)137 (45)174 (50) b 145 (45) b HDL-C48 (16)50 (17)47 (13)50 (12) Triglycerides141 (69)140 (76)164 (71)146 (69) Erdman DM, et al. Diabetes Care. 2002;25(1):9-15. a Study was conducted when NCEP II guidelines were in effect b At 1-year LDL-C was significantly decreased with drug therapy from initial (P<0.001)

Develop Strategies to Team Specialist Nurses With Diabetes Clinics  Nurse interventions included –Visits every 4 to 6 weeks –Patient education on disease, lifestyle factors, behavior changes, drug therapy, and treatment goals –Individualized action plan –Protocol-based medication adjustments  Specialist nurses-led clinics managed hyperlipidemia effectively when added to usual diabetes clinic care  32% more patients achieved cholesterol goals in the intervention arm New JP, et al. Diabetes Care. 2003;26(8): P= Percentage of patients achieving lipid goals

Nurse Care Management Improves Diabetes and Dyslipidemia Care Taylor CB, et al. Diabetes Care. 2003;26: Usual care (n=66) Intervention with nurse care manager (n=61) Change at 1 Year TC, mg/dL LDL, mg/dL HDL, mg/dL Triglycerides, mg/dL A1C, % P=0.01 P=0.02

Pharmacist-Directed Care in Diabetes: The Asheville Project Cranor CW, et al. J Am Pharm Assoc. 2003;4(2)3: Study Design Longitudinal, pre-post cohort-with-comparison group study PatientsPatients with diabetes covered by self-insured employers’ health plans (N=194 met inclusion criteria) InterventionEducation by certified diabetes educators Follow-up with community pharmacist with scheduled consultations, clinical assessment, goal setting, and monitoring Lipid management was key component of intervention Patients referred to diabetes education center or physician as needed Patients followed up to 5 years Outcome Measures Changes in A1C, LDL-C, HDL-C, and diabetes-related and total medical utilization and costs over time

Pharmacist-Directed Care Improves A1C, LDL-C, and HDL-C A1C LDL HDL Patients With Lab Values in Optimal Range*, % Follow-up Visit † Cranor CW, et al. J Am Pharm Assoc. 2003;43(2): *Optimal ranges defined as A1C 55 mg/dL (women) and >45 mg/dL (women). † Follow-up periods defined as 6-month intervals following baseline.

Pharmacist-Directed Care Improves Economic Outcomes in Patients With Diabetes Cranor CW, et al. J Am Pharm Assoc. 2003;43(2): Rx claims Insurance claims Follow-up Year Mean Cost Per Patient Per Year (US $2001)

Pharmacist-Directed Care Reduces Sick Time in Diabetes Sick Time per Patient per Year, Days (mean) Follow-Up Year Cranor CW, et al. J Am Pharm Assoc. 2003;43(2): Employer estimated increased productivity to be increased by $18,000 per year