Real-World Health and Economic Effects of a Large-Scale Outpatient Screening and Continuing Care Programme for Early Detection and Care of Microvascular Complications in Patients with Type 2 Diabetes Implemented in Routine Care Across Germany: A Quasi-Experimental Study Using Health Insurance Claims Data

Aim The aim of this study was to analyse the real-world health and economic effect of an outpatient screening and continuing-care programme for early detection and care of microvascular complications in patients with type 2 diabetes (T2D) delivered through a selective contract between a large statutory health insurance company and ambulatory care physicians in the German health care system. Methods Building on methods of target trial emulation and programme impact evaluation, we used a quasi-experimental approach and health insurance claims data from 790,375 patients with T2D over a time horizon of 5.75 years. We applied a two-stage matching approach in which we exploited the staggered implementation of the selective contract across federal states in Germany to control for selection bias at the physician level and used propensity scores to control for selection bias at the patient level, where we considered socio-demographic, health consciousness-related, care-related, and comorbidity-related potential confounders in the matching process. Results Within a matched sample of 16,490 patients, over 1 year, enrolment into the programme increased the number of visits to primary care physicians (relative risk [RR]: 1.09, 95% confidence interval [CI] 1.07, 1.10), increased the frequency of prescriptions for sodium-glucose cotransporter-2 (SGLT2) inhibitors (RR: 1.30, 95% CI 1.12, 1.50) and for statins (RR: 1.08, 95% CI 1.03, 1.13) and decreased the risk of hospitalisations (RR: 0.88, 95% CI 0.84, 0.92). Outpatient costs in the enrolled patients were on average 14% (cost ratio: 1.14, 95% CI 1.09, 1.20) or €194.4 higher, but overall, the programme was budget neutral over a time horizon of 1 year. Conclusion Investing in secondary prevention to detect and manage the early stages of microvascular complications is likely a cost-effective or cost-saving approach to improve health in patients with T2D.