Does disease management for diabetic nephropathy reduce medical expenditure? Evidence from a three-period difference-in-differences analysis

• Main Authors: Hiroyuki Kawaguchi, Michiko Moriyama, Hideki Hashimoto
• Format: Article
• Language: English
• Published: BMC 2020-05-01
• Series: BMC Health Services Research
• Subjects: Disease management; Diabetes; Dialysis; Difference-in-differences analysis; Charlson comorbidity index
• Online Access: http://link.springer.com/article/10.1186/s12913-020-05297-0

Abstract Background To discriminatively evaluate the cost-saving effects of a disease management program for diabetic nephropathy patients through care process rectification and, subsequently, improved health outcomes. Methods This study links public medical insurance claims data to the health records of a disease management program for diabetic nephropathy patients. To account for selection bias caused by the non-randomized allocation of the disease management program for diabetes patients, we adopted a fixed-effect model of panel data analysis. To discriminatively evaluate the cost-saving effects of the disease management program for diabetic nephropathy patients through care process rectification and, subsequently, improved health outcomes, we expanded the difference-in-differences analysis from the traditional two-period model to a three-period model, comprising the before-intervention, during-intervention, and after-intervention periods. Data were extracted from municipal public insurers in Kure, Japan. Results The cost-reduction effect in terms of treatment costs from the before-intervention period to the during-intervention period (the rectification effect) was 4.02%, and the cost-saving effect from the during-intervention period to the after-intervention period (the health improvement effect) was 2.95%. Conclusions A disease management program for diabetes patients organized by local public insurers in Japan reduced costs both by amending treatment processes and by subsequently improving the prognosis of the disease.