The Cost-Effectiveness of Shared Medical Appointments for Type II Diabetes at Duke Family Medicine

Abstract

With increasing healthcare expenditures above the rate of inflation, new health care delivery models are needed. Since care for chronic health conditions accounts for a majority of spending, more cost-effective ways to manage these conditions are especially necessary and could be the most effective in decreasing health care costs. Shared medical appointments (SMAs) are a promising solution because they increase patient education through group appointments while simultaneously increasing productivity by allowing a provider to see patients in a group but bill for them individually. In this study, 38 patient volunteers participated in an SMA as part of a pilot program at Duke Family Medicine (DFM). As part of this program, patients were randomly assigned to groups that offered varying versions of an SMA curriculum over the course of 3 years. Data collected included HbA1c scores, number and type of medications, type of insurance and payments, number and type of visit (including hospital admissions, emergency room visits, primary care and specialty visits), laboratory tests completed, and home address. Data was collected during, after, and for the six months prior to starting the SMAs. Data points from six months prior to the SMAs serve as a control. HbA1c served as the measure of health outcome while the rest of the data was used in estimating the total healthcare costs of control and treatment periods. Any changes in HbA1c were converted into changes in quality adjusted life years (QALYs) for the cost-effectiveness calculations. The estimated total costs and changes in QALYs were used to calculate the average cost- effectiveness of both the control and treatment periods. Given the small sample size, the SMAs appeared to be more cost-effective for patients that attended a majority of the SMA sessions. The cost-effectiveness comparison for all patients was inconclusive. This study’s calculations should be repeated once more patients complete SMAs in order to increase the power of the tests and provide conclusive results for all patients.