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Cost-effectiveness and cost-utility analyses of hospital-based home care compared to hospital-based care for children diagnosed with type 1 diabetes; a randomised controlled trial; results after two years' follow-up

Tiberg, Irén LU ; Lindgren, Björn LU ; Carlsson, Annelie LU and Hallström, Inger LU (2016) In BMC Pediatrics 16(1).
Abstract

Background: Practices regarding hospitalisation of children at diagnosis of type 1 diabetes vary both within countries and internationally, and high-quality evidence of best practice is scarce. The objective of this study was to close some of the gaps in evidence by comparing two alternative regimens for children diagnosed with type 1 diabetes: hospital-based care and hospital-based home care (HBHC), referring to specialist care in a home-based setting. Methods: A randomised controlled trial, including 60 children aged 3-15 years, took place at a university hospital in Sweden. When the children were medically stable, they were randomised to either the traditional, hospital-based care or to HBHC. Results: Two years after diagnosis there... (More)

Background: Practices regarding hospitalisation of children at diagnosis of type 1 diabetes vary both within countries and internationally, and high-quality evidence of best practice is scarce. The objective of this study was to close some of the gaps in evidence by comparing two alternative regimens for children diagnosed with type 1 diabetes: hospital-based care and hospital-based home care (HBHC), referring to specialist care in a home-based setting. Methods: A randomised controlled trial, including 60 children aged 3-15 years, took place at a university hospital in Sweden. When the children were medically stable, they were randomised to either the traditional, hospital-based care or to HBHC. Results: Two years after diagnosis there were no differences in HbA1c (p = 0.777), in episodes of severe hypoglycaemia (p = 0.167), or in insulin U/kg/24 h (p = 0.269). Over 24 months, there were no statistically significant differences between groups in how parents' reported the impact of paediatric chronic health condition on family (p = 0.138) or in parents' self-reported health-related quality of life (p = 0.067). However, there was a statistically significant difference regarding healthcare satisfaction, favouring HBHC (p = 0.002). In total, healthcare costs (direct costs) were significantly lower in the HBHC group but no statistically significant difference between the two groups in estimated lost production (indirect costs) for the family as a whole. Whereas mothers had a significantly lower value of lost production, when their children were treated within the HBHC regime, fathers had a higher, but not a significantly higher value. The results indicate that HBHC might be a cost-effective strategy in a healthcare sector perspective. When using the wider societal perspective, no difference in cost effectiveness or cost utility was found. Conclusions: Overall, there are only a few, well-designed and controlled studies that compare hospital care to different models of home care. The results of this study provide empirical support for the safety and feasibility of HBHC when a child is diagnosed with type 1 diabetes. Our results further indicate that the model of care may have an impact on families' daily living, not only during the initial period of care but for a longer period of time. Trial registration: ClinicalTrials.gov with identity number NCT00804232, December 2008.

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organization
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type
Contribution to journal
publication status
published
subject
keywords
Cost-effectiveness, Cost-utility, Direct and indirect costs, Metabolic control, Quality of life
in
BMC Pediatrics
volume
16
issue
1
publisher
BioMed Central
external identifiers
  • scopus:84987704933
  • wos:000380236700004
ISSN
1471-2431
DOI
10.1186/s12887-016-0632-8
language
English
LU publication?
yes
id
66c4c68b-7f80-4a31-98ac-a4fc65dd1ca0
date added to LUP
2016-10-06 10:15:49
date last changed
2017-01-01 08:36:08
@article{66c4c68b-7f80-4a31-98ac-a4fc65dd1ca0,
  abstract     = {<p>Background: Practices regarding hospitalisation of children at diagnosis of type 1 diabetes vary both within countries and internationally, and high-quality evidence of best practice is scarce. The objective of this study was to close some of the gaps in evidence by comparing two alternative regimens for children diagnosed with type 1 diabetes: hospital-based care and hospital-based home care (HBHC), referring to specialist care in a home-based setting. Methods: A randomised controlled trial, including 60 children aged 3-15 years, took place at a university hospital in Sweden. When the children were medically stable, they were randomised to either the traditional, hospital-based care or to HBHC. Results: Two years after diagnosis there were no differences in HbA1c (p = 0.777), in episodes of severe hypoglycaemia (p = 0.167), or in insulin U/kg/24 h (p = 0.269). Over 24 months, there were no statistically significant differences between groups in how parents' reported the impact of paediatric chronic health condition on family (p = 0.138) or in parents' self-reported health-related quality of life (p = 0.067). However, there was a statistically significant difference regarding healthcare satisfaction, favouring HBHC (p = 0.002). In total, healthcare costs (direct costs) were significantly lower in the HBHC group but no statistically significant difference between the two groups in estimated lost production (indirect costs) for the family as a whole. Whereas mothers had a significantly lower value of lost production, when their children were treated within the HBHC regime, fathers had a higher, but not a significantly higher value. The results indicate that HBHC might be a cost-effective strategy in a healthcare sector perspective. When using the wider societal perspective, no difference in cost effectiveness or cost utility was found. Conclusions: Overall, there are only a few, well-designed and controlled studies that compare hospital care to different models of home care. The results of this study provide empirical support for the safety and feasibility of HBHC when a child is diagnosed with type 1 diabetes. Our results further indicate that the model of care may have an impact on families' daily living, not only during the initial period of care but for a longer period of time. Trial registration: ClinicalTrials.gov with identity number NCT00804232, December 2008.</p>},
  articleno    = {94},
  author       = {Tiberg, Irén and Lindgren, Björn and Carlsson, Annelie and Hallström, Inger},
  issn         = {1471-2431},
  keyword      = {Cost-effectiveness,Cost-utility,Direct and indirect costs,Metabolic control,Quality of life},
  language     = {eng},
  month        = {07},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {BMC Pediatrics},
  title        = {Cost-effectiveness and cost-utility analyses of hospital-based home care compared to hospital-based care for children diagnosed with type 1 diabetes; a randomised controlled trial; results after two years' follow-up},
  url          = {http://dx.doi.org/10.1186/s12887-016-0632-8},
  volume       = {16},
  year         = {2016},
}