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A Diabetes Pay-for-Performance Program and Risks of Cancer Incidence and Death in Patients With Type 2 Diabetes in Taiwan

ORIGINAL RESEARCH — Volume 14 — October 5, 2017

PEER REVIEWED

Figure.
Adjusted model results and 95% confidence intervals for the effects of a pay-for-performance program (P4P) and prescribed antidiabetes medications on the ­risks of all-cause, cancer, and diabetes-related mortality in Taiwan. Competing risk regression models were used to analyze the effects of P4P and drug effects on risks of cancer-specific and diabetes-related mortality and the adjusted subdistribution hazard ratios were calculated. A Cox proportionate hazard model was used to analyze all-cause mortality and the adjusted hazard ratios were calculated. Potential confounders that were controlled for were age, sex, highest level of education, rural or urban residence, baseline comorbidity (diabetes complications severity index and chronic illness with complexity), antidiabetes drug use (metformin, sulfonylureas, thiazolidinediones, α glucosidase inhibitors), and health care facility characteristics (accreditation level and geographic regions).

Effect Adjusted Subdistribution Hazard Ratio (95% Confidence Interval)
All-cause mortality
P4P program 0.59 (0.55–0.63)
Metformin 0.56 (0.51–0.62)
Sulfonylureas 1.13 (1.00–1.26)
Thiazolidinediones 0.74 (0.69–0.80)
α Glucosidase inhibitors 0.93 (0.87–1.00)
Cancer mortality
P4P program 0.85 (0.73–1.00)
Metformin 0.44 (0.35–0.54)
Sulfonylureas 1.32 (1.02–1.71)
Thiazolidinediones 0.73 (0.62–0.87)
α Glucosidase inhibitors 0.72 (0.60–0.85)
Diabetes-related mortality
P4P program 0.54 (0.49–0.60)
Metformin 0.66 (0.57–0.77)
Sulfonylureas 1.02 (0.86–1.20)
Thiazolidinediones 1.00 (0.90–1.12)
α Glucosidase inhibitors 0.74 (0.66–0.83)

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