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Research Article
29 January 2025

Budget impact analyses of hemoglobin A1c and lipid panel point-of-care testing with Afinion™ 2 in Canada and Italy

Authors: David Garcia https://orcid.org/0000-0003-2097-1675 [email protected], Antonio Ruffolo, Alicyia Walczyk Mooradally https://orcid.org/0000-0003-4336-9329, Anna Zhou https://orcid.org/0000-0001-5451-4670, Emmanuel Lazaridis, and Barbara LaurelliAuthor Info & Affiliations
Volume 14, Number 3
https://doi.org/10.57264/cer-2024-0208
PDFFormats

Abstract

Aim: Screening and monitoring of diabetes or dyslipidemia frequently involves a multi-step process requiring patients to obtain test requisitions from their primary care physician (PCP), followed by a laboratory visit and re-consultation. Point-of-care testing (POCT) for hemoglobin A1c (HbA1c) and lipid panel can streamline the patient care pathway. This study assessed the budget impact of introducing Afinion™ 2 POCT (Abbott Rapid Diagnostics) from the Canadian and Italian societal perspectives. Methods: Budget impact models were developed for Canada and Italy over a 5-year time horizon (2025 to 2029). The analyses considered the screening and monitoring of diabetes or dyslipidemia for patients utilizing the public healthcare system and attending primary care, and included direct costs (testing, consultations) and indirect costs (productivity loss, transportation) based on published sources. The budget impact (BI) was calculated by comparing scenarios with and without POCT. All costs were adjusted to Canadian dollars ($) or 2024 Euros (€). Scenario analyses were conducted to explore the impact of alternative assumptions. Results: The 5-year cumulative BI was -$758,006,692 (-$50,709,964 direct, -$707,296,728 indirect) for HbA1c POCT and -$726,452,755 ($2,684,011 direct, -$729,136,766 indirect) for lipid panel POCT in Canada and -€1,380,658,764 (-€6,391,954 direct, -€1,374,266,809 indirect) for HbA1c POCT and -€851,792,115 (€55,962,879 direct, -€907,754,993 indirect) for lipid panel POCT in Italy. In both countries, cost savings for both the healthcare payer and patients were observed for HbA1c POCT, while costs savings were derived from patient indirect costs for lipid panel POCT. The analyses estimated that 1,558,062 and 1,501,260 PCP consultations in Canada, 4,962,338 and 1,951,026 PCP consultations in Italy were avoided with implementation of POCT for HbA1c and lipid panel, respectively. Scenario analyses demonstrated potential further cost savings with implementation of POCT in pharmacies. Conclusion: This study demonstrates that the adoption of Afinion 2 POCT for HbA1c and lipid panel can provide efficiencies to different types of healthcare systems through reducing PCP consultations, saving time and money for patients and providing cost savings for payers.

Plain language summary: cost of Afinion™ 2 versus traditional laboratory testing for diabetes & lipids in Canada and Italy

What was the aim of this research?

To compare the costs and change in number of primary care visits associated with the use of Afinion™ 2 point-of-care testing (POCT) for screening and monitoring of diabetes and dyslipidemia versus traditional laboratory testing for Canadian and Italian healthcare systems.

How was the research carried out?

A budget impact model was developed to compare costs between traditional laboratory testing pathways and Afinion 2 POCT over 5 years for Canada and Italy. Screening and monitoring of diabetes or dyslipidemia for patients utilizing the public healthcare system and attending primary care visits were analyzed. Direct (testing, physician visits) and indirect costs (productivity loss, transportation) were also included.

What were the results?

Utilization of Afinion 2 POCT can reduce the number of primary care and laboratory visits for patients with diabetes or dyslipidemia, resulting in decreased healthcare resource utilization and increased efficiency for both healthcare providers and patients. The overall budget impact was cost-saving for both HbA1c and lipid panel testing in Canada and Italy, with the main cost drivers being attributed to indirect cost savings and a reduction in primary care visits.

What do the results of the study mean?

Implementing Afinion 2 POCT for diabetes and lipid panel testing can make the Canadian and Italian healthcare systems more streamlined by reducing the number of primary care visits for disease management, saving money and time for patients and providing cost savings for payers.

Sharable abstract

Comparing costs of Afinion™ 2 point-of-care testing (POCT) and traditional lab testing for Canadian and Italian healthcare systems showed significant 5-year cost savings for hemoglobin A1c and lipid panel POCT. Millions of physician visits can also be avoided, enhancing system efficiencies and saving time for patients.

Supplementary Material

File (supplementary materials.pdf)

References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Forbes JM, Cooper ME. Mechanisms of diabetic complications. Physiol. Rev. 93(1), 137–188 (2013).
PubMed
Google Scholar
2.
WHO. Global Report on Diabetes. (2016). Available at: https://www.who.int/publications/i/item/9789241565257
Google Scholar
3.
Sun B, Luo Z, Zhou J. Comprehensive elaboration of glycemic variability in diabetic macrovascular and microvascular complications. Cardiovasc. Diabetol. 20(1), 9 (2021).
PubMed
Google Scholar
4.
Arvanitis M, Lowenstein CJ. Dyslipidemia. Ann. Intern. Med. 176(6), ITC81–ITC96 (2023).
PubMed
Google Scholar
5.
Petrie JR, Guzik TJ, Touyz RM. Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Can. J. Cardiol. 34(5), 575–584 (2018).
PubMed
Google Scholar
6.
Asghari S, Aref-Eshghi E, Godwin M, Duke P, Williamson T, Mahdavian M. Single and mixed dyslipidaemia in Canadian primary care settings: findings from the Canadian primary care sentinel surveillance network database. BMJ Open 5(12), e007954 (2015).
PubMed
Google Scholar
7.
Public Health Agency of Canada. Framework for Diabetes in Canada. (2022). Available at: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/framework-diabetes-canada.html
Google Scholar
8.
Mach F, Baigent C, Catapano AL et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Eur. Heart J. 41(1), 111–188 (2020).
PubMed
Google Scholar
9.
Consensus Committee. Consensus Statement on the Worldwide Standardization of the Hemoglobin A1C Measurement: The American Diabetes Association, European Association for the Study of Diabetes, International Federation of Clinical Chemistry and Laboratory Medicine, and the International Diabetes Federation. Diabetes Care 30(9), 2399–2400 (2007).
PubMed
Google Scholar
10.
Chai JH, Ma S, Heng D et al. Impact of analytical and biological variations on classification of diabetes using fasting plasma glucose, oral glucose tolerance test and HbA1c. Sci. Rep. 7(1), 13721 (2017).
PubMed
Google Scholar
11.
White-Al Habeeb NMA, Higgins V, Wolska A, Delaney SR, Remaley AT, Beriault DR. The present and future of lipid testing in cardiovascular risk assessment. Clin. Chem. 69(5), 456–469 (2023).
PubMed
Google Scholar
12.
Chadee A, Blackhouse G, Goeree R. Point-of-care hemoglobin A1c testing: a budget impact analysis. Ont. Health Technol. Assess. Ser. 14(9), 1–23 (2014).
PubMed
Google Scholar
•• Canadian health technology assessment exploring the budget impact of introducing HbA1c point-of-care testing in Ontario.
13.
Schnell O, Crocker JB, Weng J. Impact of HbA1c testing at point of care on diabetes management. J. Diabetes Sci. Technol. 11(3), 611–617 (2017).
PubMed
Google Scholar
• A review article outlining the positive impact HbA1c point-of-care testing can provide to diabetic patients to aid in disease management.
14.
Trenti T. Synergy between point-of-care testing and laboratory consolidations. EJIFCC 32(3), 328–336 (2021).
PubMed
Google Scholar
• A review article comparing point-of-care and central laboratory testing, discussing the advantages in effective care management and improved patient outcomes and satisfaction.
15.
Handrinos L, Januszewski AS, Trimble E, Donelan N, Williams P, Jenkins AJ. Point-of-care testing of HbA1c, renal function and lipids in remote or disadvantaged regions. Intern. Med. J. 50(12), 1567–1571 (2020).
PubMed
Google Scholar
16.
Laurence CO, Moss JR, Briggs NE et al. The cost–effectiveness of point of care testing in a general practice setting: results from a randomised controlled trial. BMC Health Serv. Res. 10, 165 (2010).
PubMed
Google Scholar
17.
Canadian Institute for Health Information. An overview of physician payments and cost per service [updated 11/17/2022]. Available from: https://www.cihi.ca/en/health-workforce-in-canada-in-focus-including-nurses-and-physicians/an-overview-of-physician
Google Scholar
18.
Giulio de Belvis A, Meregaglia M, Morsella A et al. Italy: Health System Review. Health Syst. Transit. 24(4), 1–236 (2022).
Google Scholar
19.
Wilson SE, Lipscombe LL, Rosella LC, Manuel DG. Trends in laboratory testing for diabetes in Ontario, Canada 1995–2005: a population-based study. BMC Health Serv. Res. 9, 41 (2009).
PubMed
Google Scholar
20.
Harris SB, Ekoé JM, Zdanowicz Y, Webster-Bogaert S. Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study). Diabetes Res. Clin. Pract. 70(1), 90–97 (2005).
PubMed
Google Scholar
21.
Redazione Diabete. Adesione alla terapia per il diabete [updated 31/12/2017]. Available from: https://www.diabete.com/adesione-alla-terapia/
Google Scholar
22.
Joffres M, Shields M, Tremblay MS, Connor Gorber S. Dyslipidemia prevalence, treatment, control, and awareness in the Canadian Health Measures Survey. Can. J. Public Health 104(3), e252–e257 (2013).
PubMed
Google Scholar
23.
Bilitou A, Were J, Farrer A, Rabe A, Ming SWY, Haq I et al. Prevalence and patient outcomes of adult primary hypercholesterolemia and dyslipidemia in the UK: longitudinal retrospective study using a primary care dataset from 2009 to 2019. Clinicoecon. Outcomes Res. 14, 189–203 (2022).
PubMed
Google Scholar
24.
Petrella RJ, Merikle E, Jones J. Prevalence and treatment of dyslipidemia in Canadian primary care: a retrospective cohort analysis. Clin. Ther. 29(4), 742–750 (2007).
PubMed
Google Scholar
25.
Statistics Canada. Annual Demographic Estimates: Canada, Provinces and Territories (Total Population only). (2023). Available from: https://www150.statcan.gc.ca/n1/pub/91-215-x/91-215-x2023001-eng.htm
Google Scholar
26.
Canadian Institute for Health Information. National Physician Database Historical Utilization – Data Tables (Table D.2.1) [updated 10/26/2023]. Available from: https://www.cihi.ca/en
Google Scholar
27.
Agenzia Nazionale per i Servizi Sanitari Regionali. Analisi comparata delle cure primarie in Europa [updated 06/07/2022]. Available from: https://www.agenas.gov.it/
Google Scholar
28.
Stephenson E, Butt DA, Gronsbell J et al. Changes in the top 25 reasons for primary care visits during the COVID-19 pandemic in a high-COVID region of Canada. PLOS One 16(8), e0255992 (2021).
PubMed
Google Scholar
• A retrospective claims analysis from the University of Toronto Practice Based Research Network (UTOPIAN) to compare the most common reasons for primary care visits to inform the population inputs for the budget impact model presented.
29.
Toth F. The Italian NHS, the public/private sector mix and the disparities in access to healthcare. Global Social Welfare 3(3), 171–178 (2016).
Google Scholar
30.
Queenan JA, Williamson T, Khan S et al. Representativeness of patients and providers in the Canadian Primary Care Sentinel Surveillance Network: a cross-sectional study. CMAJ Open 4(1), E28–E32 (2016).
PubMed
Google Scholar
31.
Ekoe JM, Goldenberg R, Katz P. Screening for diabetes in adults. Can. J. Diabetes 42(Suppl. 1), S16–S19 (2018).
PubMed
Google Scholar
32.
Ministry of Health. Schedule of Benefits for Laboratory Services. Ontario Ministry of Health (2023).
Google Scholar
33.
Pearson GJ, Thanassoulis G, Anderson TJ, Barry AR, Couture P, Dayan N et al. Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. Can. J. Cardiol. 37(8), 1129–1150 (2021).
PubMed
Google Scholar
• Canadian clinical practice guidelines for the management of dyslipidemia in adults, this source was used to inform the number of consultations and testing visits each suspected or diagnosed dyslipidemia patient is allocated in the budget impact model presented.
34.
Berberich AJ, Hegele RA. A modern approach to dyslipidemia. Endocr. Rev. 43(4), 611–653 (2022).
PubMed
Google Scholar
35.
Papastergiou J. Point-of-care screening programs in community pharmacy practice: an innovative approach to improving patient care. Canadian Pharmacists Conference 2015.
Google Scholar
• Conference presentation presented on behalf of the Canadian Pharmacists Association outlining the advantages point-of-care HbA1c testing within community pharmacies can provide to relieve the public health care system in Canada.
|