Health outcomes, financial protection, and cost-effectiveness of community chronic disease management in China: a...

Real-world evidence on the effectiveness and economic value of community chronic disease management in China remains limited. This study evaluated a structured community program.

A prospective observational cohort study enrolled adults with physician-diagnosed chronic diseases between February and August 2023 and followed them for 12 months. Participants self-selected into enrolment (n = 882) or usual care (n = 463). Follow-up outcomes included patient-reported disease control, EQ-5D-5L utility and EQ-VAS, self-management behaviors, medication adherence, hospital admissions, emergency department visits, financial pressure, and cost-utility from a societal perspective. Multivariable regressions adjusted for demographic and clinical covariates, and incremental costs and QALYs were estimated using EQ-5D utilities with bootstrap resampling.

Among 1,345 participants, baseline profiles were comparable; however, program enrollees engaged more in follow-up and telehealth and showed better self-management, including higher medication adherence (6.8 ± 1.4 vs. 6.2 ± 1.7; p < 0.001), fewer nonadherence behaviors, more daily self-monitoring (48.2% vs. 36.1%; p < 0.001), higher physical activity (4.2 ± 2.1 vs. 3.6 ± 2.3 days/week; p = 0.001), and greater self-management confidence (7.8 ± 1.6 vs. 7.1 ± 1.9; p < 0.001). Good/very good disease control was more frequent among enrollees (51.8% vs. 45.6%; p = 0.03) and remained significant after adjustment (aOR 1.34, 95% CI 1.05-1.71; p = 0.020). EQ-5D utility was higher (0.814 ± 0.122 vs. 0.795 ± 0.114; p = 0.008; adjusted β 0.019, 95% CI 0.005-0.033; p = 0.009). Hospital admissions and emergency visits did not differ significantly. High financial pressure (aOR 0.73, 95% CI 0.57-0.94) and cost-related care avoidance (aOR 0.68, 95% CI 0.48-0.96) were lower in enrollees. Mean annual societal costs decreased by 516 CNY with QALY gains of 0.019, indicating dominance and an 89.5% probability of cost-effectiveness at one-times GDP per capita^.

In routine primary care, community chronic disease management improved self-management, disease control, health-related quality of life, and financial protection while remaining cost-saving. These findings support scale-up within Healthy China 2030 and longer-term multi-center evaluation.