- Metabolic Risk/Epidemiology
- Early Enrollment in Diabetes Pay-for-Performance Program Reduced Loss of Life Expectancy in Newly-Diagnosed Patients with Type 2 Diabetes Mellitus
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Yu-Ching Chen, Wei-Ming Wang, Boniface J. Lin, Jung-Der Wang, Li-Jung Elizabeth Ku
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Received August 25, 2024 Accepted December 3, 2024 Published online March 26, 2025
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DOI: https://doi.org/10.4093/dmj.2024.0507
[Epub ahead of print]
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 Abstract
 PDF Supplementary Material PubReader  ePub
- Background
Diabetes is associated with reduced lifespan. To explore pay-for-performance (P4P) program and life expectancy (LE), we investigated the impact of interval between diabetes diagnosis and enrollment in P4P program on loss-of-LE among patients with diabetes in Taiwan.
Methods
From diabetes mellitus health database, which collected all newly-diagnosed patients with diabetes by calendar year, we selected patients, aged 40 to 64, with 503,662 in P4P group and 450,071 in non-P4P group, respectively, from 2004 to 2015, and followed them until the end of 2018 using Kaplan–Meier survival analysis. We simulated age-, gender-, and calendar yearmatched referents for each group through Monte Carlo method from Taiwan’s vital statistics. We constructed a restricted cubic spline model on logit-transformed relative survival between each group and its corresponding matched referents, and applied a rolling-over algorithm month-by-month to extrapolate the survival function of each index group to lifetime to estimate the LE, which was subtracted from that of matched referents to obtain the loss-of-LE.
Results
We found stratified analysis by interval showed that the earlier the enrollment, the lower the loss-of-LE, namely, 0.06±0.72 years for interval <1 year, 0.05±0.59 years for interval 1–4 years, 10.01±0.11 years for interval 5–9 years, and 12.77±0.14 years for interval 10–15 years, respectively (P<0.001), compared with 2.60±0.14 years for non-P4P group.
Conclusion
Early enrollment in the P4P program was associated with reduced loss-of-LE, indicating P4P might gain life if implemented early after diabetes diagnosis.
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