Improving quality of care in people with Type 2 diabetes through the Associazione Medici Diabetologi-annals initiative: a long-term cost-effectiveness analysis

Aims The Associazione Medici Diabetologi‐annals initiative is a physician‐led quality‐of‐care improvement scheme that has been shown to improve HbA1c concentration, blood pressure, lipid profiles and BMI in enrolled people with Type 2 diabetes. The present analysis investigated the long‐term cost‐effectiveness of enrolling people with Type 2 diabetes in the Associazione Medici Diabetologi‐annals initiative compared with conventional management. Methods Long‐term projections of clinical outcomes and direct costs (in 2010 Euros) were made using a published and validated model of Type 2 diabetes in people with Type 2 diabetes who were either enrolled in the Associazione Medici Diabetologi‐annals initiative or who were receiving conventional management. Treatment effects were based on mean changes from baseline seen at 5 years after enrolment in the scheme. Costs and clinical outcomes were discounted at 3% per annum. Results The Associazione Medici Diabetologi‐annals initiative was associated with improvements in mean discounted life expectancy and quality‐adjusted life expectancy of 0.55 years (95% CI 0.54–0.57) years and 0.48 quality‐adjusted life years (95% CI 0.46–0.49), respectively, compared with conventional management. Whilst treatment costs were higher in the Associazione Medici Diabetologi‐annals arm, this was offset by savings as a result of the reduced incidence and treatment of diabetes‐related complications. The Associazione Medici Diabetologi‐annals initiative was found to be cost‐saving over patient lifetimes compared with conventional management [€ 37,289 (95% CI 37,205–37,372) vs € 41,075 (95% CI 40,956–41,155)]. Conclusions Long‐term projections indicate that the physician‐led Associazione Medici Diabetologi‐annals initiative represents a cost‐saving method of improving long‐term clinical outcomes compared with conventional management of people with Type 2 diabetes in Italy. What's new? The Associazione Medici Diabetologi‐annals initiative has described improvements in physiological measurements, but this has involved increased short‐term costs. This analysis is the first to evaluate the long‐term clinical and cost outcomes of enrolling people with Type 2 diabetes in this initiative. Over patient lifetimes, enrolment in the initiative is associated with a lower incidence of diabetes‐related complications, longer life expectancy, longer quality‐adjusted life expectancy, and lower direct medical costs. Improving diabetes care in Italy through