Cost-Effectiveness Analysis of Type 2 Diabetes Disease Management in District Hospital Context: An Analysis Using CORE Diabetes Model

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Pataranuch Rujirawat
Thananan Rattanachotphanit
Chulaporn Limwattananon
Supachai Chirakup
Nathorn Chaiyakunapruk
Stephane Roze
Willium J Valentine
Andrew J Palmer
Sumon Sakolchai


Type 2 diabetes is a chronic disease which is a major health problem. Currently, the American Diabetes Association published clinical practice recommendations for diabetes care, prevention and management of complications and treatment goal. However, diabetes care in Thailand has not been complied with the guideline particularly in district hospitals due to limited resource. More than 50% of diabetic patients do not achieve target goal. The aims of this study were to calculate the projected long term clinical outcomes and cost-effectiveness analysis of diabetes disease management compared with diabetes usual care. CORE Diabetes Model was used to calculate life expectancy, quality-adjusted life expectancy (QALY), incidence of diabetes complications, lifetime cost and incremental cost-effectiveness ratio (ICER) using time frame of 35 years and health care provider perspective. Over a 35 year period, life expectancy were 9.52 and 8.39 years which were equivalent to 6.59 and 5.73 QALYs for disease management and usual care, respectively. An ICER of disease management as compared with usual care was 12,607 Baht per QALY. Moreover, disease management can decrease incidence of complications and improve time alive and free of complication. Sensitivity analysis showed that improvement in hemoglobin A1c, systolic blood pressure and coverage of renal replacement therapy led to improve cost-effectiveness. In conclusion, type 2 diabetes disease management is considered the cost-effectiveness management in district hospital context.


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