New publication on the effectiveness of German disease management programs
The disease management programs (DMPs) for type 2 diabetes and coronary heart disease in Germany are very large, and previous research has shown potentially impressive benefits related to a reduction in the risk of death. In this new study, we wanted to assess whether these DMPs have impacted moratlity rates in the elderly German population at the population level. We applied a specific type of quasi-experimental study design known as a synthetic control study. This design allowed us to compare how trends in mortality have changed in Germany since the introduction of the DMPs with how they would have changed if the DMPs had not been implemented. In order to estimate this latter hypothetical scenario, we constructed a 'synthetic control' group, which comprised data from those European countries most similar to Germany with regards to mortality and other potentially important confounders. We found that in Germany but also in all other European countries, mortality has decreased substantially in the elderly population over the study period. Our various analyses showed consistently that trends in mortality, after the introduction of the DMPs, developed very similarly in Germany and in the synthetic control group. In other words, our study observed no effect on mortality at the population-level in Germany attributed to the DMPs.
These results contrast previous studies that showed that participation in disease management programs is associated with a lower mortality. However, these results simply evidenced an association, without investigating underlying causal mechanisms.
Given the high costs associated with disease management programs (>€800 Millions per Year), robust evidence on their effectiveness is necessary. The effectiveness of these programs should be carefully evaluated not only before implementation, but also as a regular examination of existing programs.
Contact: Jacob Burns, MSc
Further publications of the Professorship of Public Health and Prevention that appeared in November 2021 can be found here and here.