Impact and Cost-Effectiveness of Integrated Psychology Services in a Pediatric Endocrinology Clinic
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Impact and Cost‑Effectiveness of Integrated Psychology Services in a Pediatric Endocrinology Clinic Laura J. Caccavale1 · Ruth Bernstein2 · Jessica L. Yarbro3 · Hilary Rushton4 · Kenneth M. Gelfand4 · Bradley A. Schwimmer4
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Including psychology services in pediatric endocrinology clinics may improve patients’ adherence to diabetes management behaviors, and, subsequently, glycemic control; however, an evaluation of the impact and cost-effectiveness of this integration is needed. The change in HbA1c and cost-effectiveness of integrated psychology services, from the hospital and insurance provider perspectives, were evaluated using a linear effects model and Incremental Cost-Effectiveness Ratios (ICERs). Data from 378 patients with T1D (50% female; 65% Caucasian; M age = 12.0 years) were obtained via medical chart review (2241 appointments). Patients demonstrated significant improvements in HbA1c following clinic visits in which they met with psychology (b = − 0.16, p = 0.006). A larger proportion of the distribution of ICER values fall below the $1000/1% HbA1c threshold from both the insurance (89%) and hospital (94%) perspectives. These results indicate that providing integrated psychology services in the endocrinology clinic is highly beneficial from the patient, hospital, and insurance provider perspectives. Keywords Pediatric · Psychology · T1 diabetes · Cost-effective
Introduction Type 1 diabetes (T1D) is a chronic condition, which affects 1.25 million Americans, with 17,900 children and adolescents newly diagnosed each year (Juvenile Diabetes Research Foundation, 2017). Treatment for T1D is costly, averaging approximately $6288 per person (adult and pediatric), annually, not including indirect costs, such as patient or parental missed school or work (Tao et al., 2010). This cost is the amount solely attributed to T1D, the burden of which is in addition to the typical healthcare expenditure of an average person. This large cost is largely the result * Laura J. Caccavale [email protected] 1
Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, P.O. Box 980140, Richmond, VA 23229‑0140, USA
2
Department of Psychology, University of Miami, Coral Gables, FL, USA
3
Pearson Education, Raleigh, NC, USA
4
Department of Pediatric Psychology and Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
of the intensity of treatment for T1D, which consists of several daily insulin injections and blood glucose checks, monitoring carbohydrate consumption, and attending routine check-ups with medical providers (The American Diabetes Association, 2015). Therefore, improving adherence to T1D treatment is crucial for health improvement and cost efficiency; greater adherence to treatment is associated with reduced healthcare resource utilization (Asche, LaFleur, & Conner, 2011), improved glycemic control, decreased hospitalization, and lower medical costs (Capoccia, O
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