Economic Evaluation of pay-for-performance program for diabetes in Taiwan

A pay for performance (P4P) program for diabetes were implemented in Taiwan from 2001. However, there exist only limited information concerning whether the P4P program affects patient's health-related quality of life. The aim of this study was to estimate the cost and consequences of patients enrolled in the P4P program. A retrospective observational study of 522 diabetic patients was conducted from 2004 to 2005. The data used in the study was from the National Health Interview Survey (NHIS). Direct cost data were obtained from NHI claim files. SF36 health module was employed to measure health-related quality-of-life and transform to utility index. Patients enrolled in the P4P program at least six months were identified as P4P patients. After propensity score matching, a total of 422 (80.9%) patients were included in the study. A single-payer perspective was assumed and cost was expressed in 2005 US dollars. Patient's age, gender, education, family income, smoking status, BMI and insulin user were not significantly different between two groups. The P4P group had an increase of 1.03 month of life at an additional cost of $111.3, thus yielding the ICER of $1083.5 per life month. The P4P group had an increase of 0.55 quality-adjust life months at an addition cost of $111.3, thus the ICER of $2015.0 per QALY. The diabetic P4P program may result in gains in both life months and quality-adjust life months. According to commonly used ICER threshold of US$50,000 per QALY, the preliminary results showed that diabetic P4P program was very cost-effective.