Diabetes care guided by quality indicators: A cost-effectiveness analysis in the Brazilian public health system

BACKGROUND: Diabetes mellitus (DM) is one of the most common non-communicable diseases worldwide and is associated with a substantial increase in the healthcare burden due to high rates of morbidity, mortality, and long-term complications. Evidence on the economic impact of quality of care for diabetes management based on structured assessment indicators in real-world primary care settings is scarce. This study aimed to evaluate the cost-effectiveness of providing qualified care to individuals with diabetes in primary healthcare settings based on quality-of-care indicators. METHODS: A cost-effectiveness analysis was conducted using a Markov-based model from the perspective of a municipal health manager in Brazil. Data were collected from 114 patients aged 60 years or older with type 2 diabetes mellitus in Vitória da Conquista. Patients were grouped based on whether 15 or more structured quality-of-care indicators were assessed during follow-up visits. The model simulated health state transitions over a 10-year time horizon, incorporating probabilities of complications, quality-adjusted life years (QALYs), and direct costs. Sensitivity and probabilistic analyses were performed to test model robustness. RESULTS: Data mining techniques were used to find a better association between the assessed items and a lower probability of having complications. It was found that in the group with 15 or more items assessed at visits, 17.4% had complications, and in the group with fewer than 15 items assessed, this percentage was 37.14%. Therefore, they were used as comparators in the economic model. The cost-effectiveness analysis showed that the most comprehensive assessment was the dominant strategy, with an incremental cost-effectiveness ratio of -US$9742.51. The factors that most influenced the model were quality-adjusted life years, the probability of experiencing complications, and the cost of diabetes. CONCLUSION: Qualified care with a comprehensive approach during follow-up visits was shown to be a cost-effective strategy for improving the quality of life of people with DM.