One influential model of disease management is the Chronic Care Model (CCM) developed in the US by Wagner, Austin et al. ( A systematic review evaluated the impact of disease management programmes that contained two or more of those CCM components for diabetes, depression, heart failure and COPD (de Bruin et al., It found that, of the studies that reported changes in healthcare costs, 13 out of 21 showed a decrease in overall costs. The overall costs varied between -USD 16 996 (a system cost saving) and USD 3 305 (an increase in the system cost) per patient per year (in 2007 prices).