The economic effectiveness of chronic disease management programs: A meta-analysis

Scope of study. The effectiveness of disease management programs, which are designed to improve the clinical and economic outcomes for chronically ill individuals, has been evaluated extensively. A literature search was performed with MEDLINE and other sources for the period covering January 1995 to September 2003. The search was limited to empirical articles that measured the direct economic outcomes for asthma, diabetes, and heart disease management programs. Of the 360 articles and presentations evaluated, only 67 met the selection criteria for meta-analysis, which included 32,041 subjects. Although some studies contained multiple measurements of direct economic outcomes, only one average effect size per study was included in the meta-analysis. To account for possible methodological bias, two methods for weighting the studies were employed.; Findings and conclusions. Based on the studies included in the research, the meta-analysis provided a statistically significant answer to the question of whether disease management programs are economically effective. The magnitude of the observed average effect size for equally weighted studies was 0.311 (95% CI = 0.272–0.350) and 0.286 (95% CI = 0.269–0.302) for quality weighted studies. Statistically significant differences of effect sizes by disease type were not found after a moderating variable, disease severity, was taken into consideration. The meta-analyses indicated that the intensity of disease management program interventions was significant in explaining effect size; however, it is likely that disease management providers adjust their service offerings to meet the needs of the enrolled subjects based on the level of disease severity.; The results of the meta-analysis suggest that disease management programs are more effective economically with severely ill enrollees and that chronic disease program interventions are most effective when coordinated with the overall level of disease severity. It appears that the findings can be generalized, which may assist health care policymakers and practitioners in addressing the issue of providing economically effective care for the growing number of individuals with chronic illness. The passage of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 will increase the level of importance in the overall economic effectiveness of chronic disease management programs and the significance of this study's results.