Avalere Health
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Avalere Recognized for Contribution in Diabetes at ISPOR Dublin

November 08, 2013

ISPOR recognized Avalere Health for its contribution in diabetes research at this week’s ISPOR 16th Annual European Congress in Dublin.

A poster prepared by Kathy Hughes, Vice President, received a finalist award from among more than 3,000 entries.  The poster was titled, “Using A ‘Standards of Care Economic Model’ To Quantify Barriers and Potential Solutions to Providing Optimal Guideline-Driven Care to Patients with Diabetes Mellitus in the United States.”   


Its content described work that she performed with and was endorsed by the Diabetes Working Group, representing the American Academy of Pediatrics, American Association of Clinical Endocrinology, American Association of Diabetes Educators, American Diabetes Association, The Endocrine Society, Juvenile Diabetes Research Foundation, and Pediatric Endocrine Society. The work was funded by unrestricted educational grants from: Abbott Diabetes Care; Animas Corporation, a Johnson & Johnson Company; Bayer HealthCare, Diabetes Care; DexCom, Inc; Johnson and Johnson; LifeScan, Inc., a Johnson & Johnson Company; Medtronic Diabetes; Roche Diagnostics; and Sanofi-Aventis. 



An abstract of the work is as follows:



Objectives:





  • Build economic model to estimate resources to deliver current standards of care to US diabetes patients





  • Evaluate provider costs to meet standards, assess patient outcomes specified in guidelines relative to reimbursement


Results:     





  • Baseline scenarios show provider costs exceed reimbursements for all type patients; best case indicates same in 5 of 6 scenarios





  • In different scenarios, the costs of treating adults exceed reimbursement by >$750,000 per year; practices would require 19%-64% increase to breakeven


  • In pediatric practice, costs exceed reimbursement by> $471,000 per year


  • Gaps are increased for patients using CSII and CGM


  • Results are more sensitive to reimbursement for routine physician care and lifestyle modification services than other variables


Conclusions:





  • 7 American professional societies comprising the Diabetes Working Group (DWG) concur delivering high-quality, guideline-based diabetes care unrealistic given current care and payment paradigms





  • DWG recommends alternative approaches in 3 areas: care management, payment reform, and workforce supply, to mitigate increasing medical and financial impact of this epidemic chronic illness


  • The model can be used internationally to support public policy efforts
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