Disease Management Program in patients with type 2 diabetes mellitus, long-term results of the early and established program cohort: A population-based retrospective cohort study

BACKGROUND: The aim of this study was to evaluate the long-term follow up of the early and the effectiveness of the established program of the Austrian Disease Management Program (DMP) ‘Therapie aktiv—Diabetes im Griff’ for patients with type 2 diabetes mellitus concerning mortality, major macrovascular complications, costs and process quality of care parameters. METHODS: We conducted a propensity score matched cohort study based on routine health insurance data for type 2 diabetic patients. The observational period from the matched early program cohort starts from January 1, 2009 to December 31, 2017 and includes 7181 DMP participants and 21543 non-participants. In the established matched program cohort, 3087 DMP participants and 9261 non-participants were observed within January 1, 2014 to December 31, 2017. RESULTS: In the early program cohort, 22.1% of the patients in the DMP-group and 29.7% in the control-group died after 8 years follow-up (HR = 0.70; 95% CI: 0.66–0.73). A difference of € 1070 (95% bootstrap-T interval: € 723 - € 1412) in mean total costs per year was observed. In the established program cohort, 10.4% DMP participants died 4 years after enrollment, whereas in the control-group 11.9% of the patients died (HR = 0.88, 95% CI: 0.78–0.99). Healthcare utilization is higher in the DMP-group (75%-96%) compared to the control-group (63%-90%). CONCLUSIONS: The 8-year long-term follow up of the DMP program showed a relevant improvement of survival and healthcare costs of patients with type 2 diabetes. The established program cohort had improved survival and quality of care. Our findings indicate that the DMP "Therapie aktiv" provides a long-term advantage for type 2 diabetes patients.