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Cost-effectiveness of Diabetes Self-management Programs in Community Primary Care SettingsFrom the National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Washington University School of Medicine in St Louis, St Louis, Missouri (Ms Brownson); Research Triangle Institute International (RTI), RTI–University of North Carolina Center of Excellence in Health Promotion Economics, Research Triangle Park, North Carolina (Dr Hoerger); National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative and Peers for Progress, Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (Dr Fisher); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (Dr Kilpatrick). Correspondence to Carol A. Brownson, MSPH, Deputy Director, National Program Office, Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Washington University School of Medicine, 4444 Forest Park Ave, Suite 6700, St Louis, MO 63108-2212 (cbrownso{at}dom.wustl.edu). Purpose The purpose of this study is to estimate the cost-effectiveness of diabetes self-management programs in real-world community primary care settings. Estimates incorporated lifetime reductions in disease progression, costs of adverse events, and increases in quality of life. Methods Clinical results and costs were based on programs of the Diabetes Initiative of the Robert Wood Johnson Foundation, implemented in primary care and community settings in disadvantaged areas with notable health disparities. Program results were used as inputs to a Markov simulation model to estimate the long-term effects of self-management interventions. A health systems perspective was adopted. Results The simulation model estimates that the intervention does reduce discounted lifetime treatment and complication costs by $3385, but this is more than offset by the $15 031 cost of implementing the intervention and maintaining its effects in subsequent years. The intervention is estimated to reduce long-term complications, leading to an increase in remaining life-years and quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio is $39 563/QALY, well below a common benchmark of $50 000/QALY. Sensitivity analyses tested the robustness of the model's estimates under various alternative assumptions. The model generally predicts acceptable cost-effectiveness ratios. Conclusions Self-management programs for type 2 diabetes are cost-effective from a health systems perspective when the cost savings due to reductions in long-term complications are recognized. These findings may justify increased reimbursement for effective self-management programs in diverse settings.
This version was published on September
1, 2009 The Diabetes Educator, Vol. 35, No. 5,
761-769 (2009) |
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