การวิเคราะห์ต้นทุนประสิทธิผลของระบบการดูแลผู้ป่วยเป็นศูนย์กลางในหน่วยบริการปฐมภูมิเปรียบเทียบกับระบบบริการปกติในโรงพยาบาลในผู้ป่วยเบาหวานชนิดที่ 2 อำเภอพิมาย จังหวัดนครราชสีมา

Abstract

Introduction : Patient-centered care in diabetes is another approach for outcome improvement, yet the supporting economic and clinical evidence remains limited in Thailand. Objectives : This study compared health outcomes and cost-utility of implementing Patient-Centered Care Systems (PCCS) in a primary care setting vs. the Routine Service System (RSS) in a hospital setting. Methods : The economic evaluation was performed using a randomized controlled study design. The participants aged ≥18 were enrolled from Phimai City in Nakhon Ratchasima Province, Thailand from June 2022 to February 2023. Totally, 309 well-controlled patients with initial care in a hospital were referred to receive the PCCS at the primary care setting or remained receiving the RSS in the hospital. Outcomes of different approaches such as fasting blood sugar, Hemoglobin A1c (HbA1c), direct medical costs, direct nonmedical costs and utility were prospectively collected at months 0, 3 and 6. Fisher’s exact test, t-test or Wilcoxon signed-rank test were used to analyze data, whichever was appropriate. An incremental cost-effectiveness ratio was calculated, and various sensitivity analyses were performed. Results : The PCCS showed significantly reduced HbA1c (p<0.001) and a greater number of patients with improved HbA1c (p<0.001). The PCCS were a cost-saving strategy due to incurring lower total costs (60.15 vs. 73.42 USD) and gaining more quality-adjusted life-years (QALY)(0.340 vs. 0.330) compared with the RSS. With a ceiling ratio of 4,659 USD/QALY, the PCCS had a 94.6 % probability of being cost-effective. Conclusion : This finding indicated that the PCCS in a primary care setting was a cost-saving strategy by lowering cost, providing a higher quality of life and improving glycemic control compared with the RSS in a hospital setting. However, generalizing the findings in a country as a whole, the economic evaluation of PCCS and RSS should be conducted among different levels of hospitals from all regions in Thailand.