CLINICAL AND ECONOMIC EVALUATION OF POSSIBLE IMPLEMENTATION OF "PAY-FORPERFORMANCE" PROGRAM FOR PATIENT WITH TYPE 2 DIABETES MELLITUS IN BULGARIA

Introduction: The aim of this analysis is to assess the cost-effectiveness of the implementation of "pay-for-performance" (P4P) program to improve the control of patients with type 2 diabetes mellitus (DM), by having an acceptable glycemic control through pharmacotherapy. Materials and methods: Patient-related health outcomes and saved direct medical costs by the NHIF in reducing the HbA1c level by 1% because of incentives under a P4P program were analyzed. A cost-benefit analysis was used to evaluate the cost-effectiveness of DM type 2 control. The final cost of pharmacotherapy was discounted with an annual discount factor of 3·5%. Results: The cumulative discounted cost for intensified pharmacotherapy of DM type 2 for a ten-year follow-up period, is 6 425·63 BGN per patient. The effect of treatment, expressed in a reduction in the level of HbA1c by 1%, is related to savings from reduced diabetes-related complications (BGN 2 224·92 per patient). The calculated ACER values are below the threshold for favorable cost-effectiveness (ACER = 14 943·32 ÷ 53 546·91 BGN/% risk reduction). The result of adequate glycemic control stands out with the lowest value for ACER and the reduction in the risk of amputation or death from a microvascular event (ACER = $14 943·32/% risk reduction). Conclusion: The economic assessment provides cost-effective measures of the effect of treatment that can be included in the P4P program.