Value for Money for Diabetes Pathway: An interdisciplinary and shared approach.

Background / Objectives Since 2009, the MeS Laboratory, in collaboration with the London School of Economics (LSE), has developed a priority setting project in Pisa and Empoli Local Health Authorities (LHAs), through the application of the Value for Money (VfM) methodology. In November 2010 professionals and researchers decided to focus on the diabetes pathway of Empoli LHA to identify interventions’ costs and benefits and define the priorities for action. Methods / Design The LHA professionals, consisting of diabetes specialists, general practitioners, nurses, epidemiologists and representatives of the Control Management unit, met with MeS researchers to share criteria to define interventions’ target population, benefits, costs and probabilities of success. Researchers analyzed the existing literature and evidences to determine probabilities of success and benefits, in terms of lifetime discounted QALYs, and estimated interventions’ costs on the basis of LHA’s administrative documents and data. The comparison between the interventions is based on their VfM and it allows setting up an “efficient frontier” in order to prioritize them. Results / Findings Looking at the results of the efficient frontier, the priorities for action are the two prevention interventions, related to amputation and primary prevention for patients at risk. The following interventions are the Disease Management Program, the monitoring of gestational diabetes and the specialist treatment. These results confirm international guidelines that promote prevention and integrated and proactive treatment models. Conclusions / Implications The VfM methodology represents a valuable support to healthcare management to set priorities and reallocate resources. Moreover, the shared decision-making encourages dialogue between different professionals to improve effectiveness and efficiency of health interventions.