The cost-effectiveness of primary care for Indigenous Australians with diabetes living in remote Northern Territory communities

Susan L Thomas, Yuejen Zhao, Steven L Guthridge and John Wakerman
Med J Aust 2014; 200 (11): 658-662. || doi: 10.5694/mja13.11316


Objective: To evaluate the costs and health outcomes associated with primary care use by Indigenous people with diabetes in remote communities in the Northern Territory.

Design, setting and participants: A population-based retrospective cohort study from 1 January 2002 to 31 December 2011 among Indigenous NT residents ≥ 15 years of age with diabetes who attended one of five hospitals or 54 remote clinics in the NT.

Main outcome measures: Hospitalisations, potentially avoidable hospitalisations (PAH), mortality and years of life lost (YLL). Variables included disease stage (new, established or complicated cases) and primary care use (low, medium or high).

Results: 14 184 patients were eligible for inclusion in the study. Compared with the low primary care use group, the medium-use group (patients who used primary care 2–11 times annually) had lower rates of hospitalisation, lower PAH, lower death rates and fewer YLL. Among complicated cases, this group showed a significantly lower mean annual hospitalisation rate (1.2 v 6.7 per person [P < 0.001]) and PAH rate (0.72 v 3.64 per person [P < 0.001]). Death rate and YLL were also significantly lower (1.25 v 3.77 per 100 population [P < 0.001] and 0.29 v 1.14 per person-year [P < 0.001], respectively). The cost of preventing one hospitalisation for diabetes was $248 for those in the medium-use group and $739 for those in the high-use group. This compares to $2915, the average cost of one hospitalisation.

Conclusion: Improving access to primary care in remote communities for the management of diabetes results in net health benefits to patients and cost savings to government.

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  • Susan L Thomas1,3
  • Yuejen Zhao2,1,3
  • Steven L Guthridge2,1,3
  • John Wakerman1,3

  • 1 Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, NT.
  • 2 Health Gains Planning Branch, Department of Health, Darwin, NT.
  • 3 Centre of Research Excellence in Rural and Remote Primary Health Care, Bendigo, VIC.



We gratefully acknowledge colleagues from remote health centres and information services for their long-term commitment to clinical data collection and development of the primary care information system. The research reported in this article is a project of the Australian Primary Health Care Research Institute (APHCRI), which is supported by a grant from the Australian Government as represented by the Department of Health. The information and opinions in it do not necessarily reflect the views or policy of the APHCRI, the Commonwealth of Australia or the Department of Health.

Competing interests: No relevant disclosures.


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