Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, 10th Floor, Eaton North, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
Health Res Policy Syst. 2024 May 13;22(1):57. doi: 10.1186/s12961-024-01135-5.
Indigenous populations have increased risk of developing diabetes and experience poorer treatment outcomes than the general population. The FORGE AHEAD program partnered with First Nations communities across Canada to improve access to resources by developing community-driven primary healthcare models.
This was an economic assessment of FORGE AHEAD using a payer perspective. Costs of diabetes management and complications during the 18-month intervention were compared to the costs prior to intervention implementation. Cost-effectiveness of the program assessed incremental differences in cost and number of resources utilization events (pre and post). Primary outcome was all-cause hospitalizations. Secondary outcomes were specialist visits, clinic visits and community resource use. Data were obtained from a diabetes registry and published literature. Costs are expressed in 2023 Can$.
Study population was ~ 60.5 years old; 57.2% female; median duration of diabetes of 8 years; 87.5% residing in non-isolated communities; 75% residing in communities < 5000 members. Total cost of implementation was $1,221,413.60 and cost/person $27.89. There was increase in the number and cost of hospitalizations visits from 8/$68,765.85 (pre period) to 243/$2,735,612.37. Specialist visits, clinic visits and community resource use followed this trend.
Considering the low cost of intervention and increased care access, FORGE AHEAD represents a successful community-driven partnership resulting in improved access to resources.
与一般人群相比，原住民人群患糖尿病的风险更高，治疗效果更差。FORGE AHEAD 项目与加拿大各地的原住民社区合作，通过开发以社区为驱动的初级保健模式来改善资源获取。
这是对 FORGE AHEAD 的经济评估，采用支付者视角。比较了 18 个月干预期间的糖尿病管理和并发症成本与干预实施前的成本。该计划的成本效益评估了资源利用事件（干预前后）的增量成本和数量差异。主要结果是全因住院。次要结果是专科就诊、诊所就诊和社区资源利用。数据来自糖尿病登记处和已发表的文献。成本以 2023 年加元表示。
研究人群的平均年龄约为 60.5 岁；57.2%为女性；糖尿病病程中位数为 8 年；87.5%居住在非隔离社区；75%居住在社区<5000 名成员。实施总成本为 1,221,413.60 加元，人均成本为 27.89 加元。从 8/68,765.85 美元（干预前）增加到 243/2,735,612.37 美元，住院次数和费用增加。专科就诊、诊所就诊和社区资源利用也呈现出这种趋势。
考虑到干预成本低，且能够增加医疗资源获取，FORGE AHEAD 代表了一个成功的以社区为驱动的合作伙伴关系，改善了资源获取。
