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Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting

Objective: We evaluated the cost-effectiveness of the point-of-care A1c (POC-A1c) test device vs. the traditional laboratory dosage in a primary care setting for people living with type 2 diabetes. Materials and Methods: The Markov model with a 10-year time horizon was based on data from the HealthR...

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Autores principales: Rosa, Lorena de Sousa, Mistro, Sóstenes, Oliveira, Marcio Galvão, Kochergin, Clavdia Nickolaevna, Cortes, Mateus Lopes, de Medeiros, Danielle Souto, Soares, Daniela Arruda, Louzado, José Andrade, Silva, Kelle Oliveira, Bezerra, Vanessa Moraes, Amorim, Welma Wildes, Barone, Mark, Passos, Luiz Carlos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851089/
https://www.ncbi.nlm.nih.gov/pubmed/33542687
http://dx.doi.org/10.3389/fphar.2020.588309
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author Rosa, Lorena de Sousa
Mistro, Sóstenes
Oliveira, Marcio Galvão
Kochergin, Clavdia Nickolaevna
Cortes, Mateus Lopes
de Medeiros, Danielle Souto
Soares, Daniela Arruda
Louzado, José Andrade
Silva, Kelle Oliveira
Bezerra, Vanessa Moraes
Amorim, Welma Wildes
Barone, Mark
Passos, Luiz Carlos
author_facet Rosa, Lorena de Sousa
Mistro, Sóstenes
Oliveira, Marcio Galvão
Kochergin, Clavdia Nickolaevna
Cortes, Mateus Lopes
de Medeiros, Danielle Souto
Soares, Daniela Arruda
Louzado, José Andrade
Silva, Kelle Oliveira
Bezerra, Vanessa Moraes
Amorim, Welma Wildes
Barone, Mark
Passos, Luiz Carlos
author_sort Rosa, Lorena de Sousa
collection PubMed
description Objective: We evaluated the cost-effectiveness of the point-of-care A1c (POC-A1c) test device vs. the traditional laboratory dosage in a primary care setting for people living with type 2 diabetes. Materials and Methods: The Markov model with a 10-year time horizon was based on data from the HealthRise project, in which a group of interventions was implemented to improve diabetes and hypertension control in the primary care network of the urban area of a Brazilian municipality. A POC-A1c device was provided to be used directly in a primary care unit, and for a period of 18 months, 288 patients were included in the point-of-care group, and 1,102 were included in the comparison group. Sensitivity analysis was performed via Monte Carlo simulation and tornado diagram. Results: The results indicated that the POC-A1c device used in the primary care unit was a cost-effective alternative, which improved access to A1c tests and resulted in an increased rate of early control of blood glucose. In the 10-year period, POC-A1c group presented a mean cost of US$10,503.48 per patient and an effectiveness of 0.35 vs. US$9,992.35 and 0.09 for the traditional laboratory test, respectively. The incremental cost was US$511.13 and the incremental effectiveness was 0.26, resulting in an incremental cost-effectiveness ratio of 1,947.10. In Monte Carlo simulation, costs and effectiveness ranged between $9,663.20–$10,683.53 and 0.33–0.37 for POC-A1c test group, and $9,288.28–$10,413.99 and 0.08–0.10 for traditional laboratory test group, at 2.5 and 97.5 percentiles. The costs for nephropathy, retinopathy, and cardiovascular disease and the probability of being hospitalized due to diabetes presented the greatest impact on the model’s result. Conclusion: This study showed that using POC-A1c devices in primary care settings is a cost-effective alternative for monitoring glycated hemoglobin A1c as a marker of blood glucose control in people living with type 2 diabetes. According to our model, the use of POC-A1c device in a healthcare unit increased the early control of type 2 diabetes and, consequently, reduced the costs of diabetes-related outcomes, in comparison with a centralized laboratory test.
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spelling pubmed-78510892021-02-03 Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting Rosa, Lorena de Sousa Mistro, Sóstenes Oliveira, Marcio Galvão Kochergin, Clavdia Nickolaevna Cortes, Mateus Lopes de Medeiros, Danielle Souto Soares, Daniela Arruda Louzado, José Andrade Silva, Kelle Oliveira Bezerra, Vanessa Moraes Amorim, Welma Wildes Barone, Mark Passos, Luiz Carlos Front Pharmacol Pharmacology Objective: We evaluated the cost-effectiveness of the point-of-care A1c (POC-A1c) test device vs. the traditional laboratory dosage in a primary care setting for people living with type 2 diabetes. Materials and Methods: The Markov model with a 10-year time horizon was based on data from the HealthRise project, in which a group of interventions was implemented to improve diabetes and hypertension control in the primary care network of the urban area of a Brazilian municipality. A POC-A1c device was provided to be used directly in a primary care unit, and for a period of 18 months, 288 patients were included in the point-of-care group, and 1,102 were included in the comparison group. Sensitivity analysis was performed via Monte Carlo simulation and tornado diagram. Results: The results indicated that the POC-A1c device used in the primary care unit was a cost-effective alternative, which improved access to A1c tests and resulted in an increased rate of early control of blood glucose. In the 10-year period, POC-A1c group presented a mean cost of US$10,503.48 per patient and an effectiveness of 0.35 vs. US$9,992.35 and 0.09 for the traditional laboratory test, respectively. The incremental cost was US$511.13 and the incremental effectiveness was 0.26, resulting in an incremental cost-effectiveness ratio of 1,947.10. In Monte Carlo simulation, costs and effectiveness ranged between $9,663.20–$10,683.53 and 0.33–0.37 for POC-A1c test group, and $9,288.28–$10,413.99 and 0.08–0.10 for traditional laboratory test group, at 2.5 and 97.5 percentiles. The costs for nephropathy, retinopathy, and cardiovascular disease and the probability of being hospitalized due to diabetes presented the greatest impact on the model’s result. Conclusion: This study showed that using POC-A1c devices in primary care settings is a cost-effective alternative for monitoring glycated hemoglobin A1c as a marker of blood glucose control in people living with type 2 diabetes. According to our model, the use of POC-A1c device in a healthcare unit increased the early control of type 2 diabetes and, consequently, reduced the costs of diabetes-related outcomes, in comparison with a centralized laboratory test. Frontiers Media S.A. 2021-01-19 /pmc/articles/PMC7851089/ /pubmed/33542687 http://dx.doi.org/10.3389/fphar.2020.588309 Text en Copyright © 2021 Rosa, Mistro, Oliveira, Kochergin, Cortes, Medeiros, Soares, Louzado, Silva, Bezerra, Amorim, Barone and Passos. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
Rosa, Lorena de Sousa
Mistro, Sóstenes
Oliveira, Marcio Galvão
Kochergin, Clavdia Nickolaevna
Cortes, Mateus Lopes
de Medeiros, Danielle Souto
Soares, Daniela Arruda
Louzado, José Andrade
Silva, Kelle Oliveira
Bezerra, Vanessa Moraes
Amorim, Welma Wildes
Barone, Mark
Passos, Luiz Carlos
Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting
title Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting
title_full Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting
title_fullStr Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting
title_full_unstemmed Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting
title_short Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting
title_sort cost-effectiveness of point-of-care a1c tests in a primary care setting
topic Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851089/
https://www.ncbi.nlm.nih.gov/pubmed/33542687
http://dx.doi.org/10.3389/fphar.2020.588309
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