PMID- 35027420
OWN - NLM
STAT- MEDLINE
DCOM- 20220315
LR  - 20220430
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 12
IP  - 1
DP  - 2022 Jan 13
TI  - Understanding the cost of care of type 2 diabetes mellitus - a value measurement 
      perspective.
PG  - e053001
LID - 10.1136/bmjopen-2021-053001 [doi]
LID - e053001
AB  - OBJECTIVES: We explore the cost of care of type 2 diabetes mellitus (T2DM) using 
      time-driven activity-based costing (TDABC) and connect that cost to resulting 
      patient health outcomes. DESIGN: We construct six care pathways varying from 
      low-risk to high-risk patients over a 12-month cycle of care. We collect time, 
      resource and cost data on activities in each care pathway and compute a 
      time-driven estimate of cost. Use of patient outcome data highlights the health 
      outcomes achieved. SETTING: Primary, secondary and tertiary care. PARTICIPANTS: 
      Medical staff involved in the care of patients with T2DM. PRIMARY AND SECONDARY 
      MEASURES: Primary: resources consumed to provide T2DM care. Secondary: health 
      outcomes for representative patient within each patient category. RESULTS: By 
      computing cost of T2DM care and associated complications of chronic kidney 
      disease, active foot disease, moderate risk of active foot disease and myocardial 
      infarction, we show that when patients develop acute complications, significant 
      costs are incurred, as compared with the cost of maintaining a patient at low or 
      moderate risk. Variance analysis further informs decision making by showing the 
      need to have the right personnel doing the right tasks at the right time to 
      control costs. CONCLUSIONS: A TDABC approach facilitates an understanding of the 
      drivers of cost in chronic illness care. Our paper highlights the stages in the 
      care pathway where different settings, decision making and a more optimal use of 
      resources could assist with achievement of better patient outcomes.
CI  - (c) Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Doyle, Gerardine Anne
AU  - Doyle GA
AUID- ORCID: 0000-0001-8516-4431
AD  - College of Business, University College Dublin, National University of Ireland, 
      Dublin, Ireland gerardine.doyle@ucd.ie.
AD  - Geary Institute for Public Policy, University College Dublin, National University 
      of Ireland, Dublin, Ireland.
FAU - O'Donnell, Shane
AU  - O'Donnell S
AD  - College of Business, University College Dublin, National University of Ireland, 
      Dublin, Ireland.
AD  - Geary Institute for Public Policy, University College Dublin, National University 
      of Ireland, Dublin, Ireland.
FAU - Cullen, Kate
AU  - Cullen K
AD  - College of Business, University College Dublin, National University of Ireland, 
      Dublin, Ireland.
FAU - Quigley, Etain
AU  - Quigley E
AD  - Applied Research for Connected Health, University College Dublin, National 
      University of Ireland, Dublin, Ireland.
FAU - Gibney, Sarah
AU  - Gibney S
AD  - Geary Institute for Public Policy, University College Dublin, Dublin, Ireland.
AD  - Department of Health and Children, Dublin, Ireland.
CN  - Diabetes Literacy Consortium
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220113
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
SB  - IM
MH  - Chronic Disease
MH  - *Diabetes Mellitus, Type 2/therapy
MH  - Humans
PMC - PMC8762124
OTO - NOTNLM
OT  - *general diabetes
OT  - *health economics
OT  - *health policy
OT  - *quality in healthcare
COIS- Competing interests: None declared.
EDAT- 2022/01/15 06:00
MHDA- 2022/03/16 06:00
PMCR- 2022/01/13
CRDT- 2022/01/14 05:43
PHST- 2022/01/14 05:43 [entrez]
PHST- 2022/01/15 06:00 [pubmed]
PHST- 2022/03/16 06:00 [medline]
PHST- 2022/01/13 00:00 [pmc-release]
AID - bmjopen-2021-053001 [pii]
AID - 10.1136/bmjopen-2021-053001 [doi]
PST - epublish
SO  - BMJ Open. 2022 Jan 13;12(1):e053001. doi: 10.1136/bmjopen-2021-053001.