Doyle, Geraldine and O'Donnell, Shane and Quigley, Etain and Cullen, Kate and Gibney, Sarah and Levin-Zamir, Diane and Ganahl, Kristin and Müller, Gabriele and Muller, Ingrid and Terkildsen Maindal, Helle and Chang, Wushou Peter and Van Den Broucke, Stephan (2017) Patient level cost of diabetes self-management education programmes: an international evaluation. BMJ Open, 7. pp. 1-9. ISSN 2044-6055

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Abstract

Objectives: The objective of this study was to examine the value of time-driven activity-based costing (TDABC) in understanding the process and costs of delivering diabetes self-management education (DSME) programmes in a multicountry comparative study. Setting: Outpatient settings in five European countries (Austria, Denmark, Germany, Ireland, UK) and two countries outside Europe, Taiwan and Israel. Participants: Providers of DSME programmes across participating countries (N=16) including healthcare professionals, administrators and patients taking part in DSME programmes. Primary and secondary measures: Primary measure: time spent by providers in the delivery of DSME and resources consumed in order to compute programme costs. Secondary measures: self-report measures of behavioural self-management and diabetes disease/health-related outcomes. Results: We found significant variation in costs and the processes of how DSME programmes are provided across and within countries. Variations in costs were driven by a combination of price variances, mix of personnel skill and efficiency variances. Higher cost programmes were not found to have achieved better relative outcomes. The findings highlight the value of TDABC in calculating a patient level cost and potential of the methodology to identify process improvements in guiding the optimal allocation of scarce resources in diabetes care, in particular for DSME that is often underfunded. Conclusions: This study is the first to measure programme costs using estimates of the actual resources used to educate patients about managing their medical condition and is the first study to map such costs to self-reported behavioural and disease outcomes. The results of this study will inform clinicians, managers and policy makers seeking to enhance the delivery of DSME programmes. The findings highlight the benefits of adopting a TDABC approach to understanding the drivers of the cost of DSME programmes in a multicountry study to reveal opportunities to bend the cost curve for DSME.

Item Type:	Article
Keywords:	Cost; Health literacy; Self-management; Time-driven activity based costing;
Academic Unit:	Faculty of Social Sciences > School of Business
Item ID:	15934
Identification Number:	https://doi.org/10.1136/bmjopen-2016-013805
Depositing User:	Kate Cullen
Date Deposited:	10 May 2022 15:03
Journal or Publication Title:	BMJ Open
Publisher:	BMJ Publishing Group
Refereed:	Yes
URI:	Publisher
Use Licence:	This item is available under a Creative Commons Attribution Non Commercial Share Alike Licence (CC BY-NC-SA). Details of this licence are available here

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