The Community Diabetes Education (CoDE) Program Cost-Effectiveness and Health Outcomes

作者：Prezio Elizabeth A^*; Pagan Jose A; Shuval Kerem; Culica Dan

来源：American Journal of Preventive Medicine, 2014, 47(6): 771-779.

DOI：10.1016/j.amepre.2014.08.016

Background: Limited evidence exists regarding the long-term effects of community health worker led diabetes management programs on health outcomes and cost-effectiveness, particularly in low-income, ethnic minority populations. %26lt;br%26gt;Purpose: To examine the long-term cost-effectiveness and improvements in diabetes-related complications of a diabetes education and management intervention led by community health workers among uninsured Mexican Americans. %26lt;br%26gt;Methods: Clinical data, changes in hemoglobin A1c over 12 months, and costs from an RCT of 180 uninsured Mexican Americans with type 2 diabetes conducted in 2006 were utilized for secondary analyses in 2012. Simulation modeling was used to estimate long-term cost and health outcomes using the validated Archimedes Model. The absolute differences for the incremental cost-effectiveness ratios and cumulative incidence of diabetes-related complications were derived by comparing intervention and control groups. %26lt;br%26gt;Results: During a 20-year time horizon, participants who received the intervention would be expected to have significantly lower hemoglobin Alc levels (p%26lt;0.001), fewer foot ulcers (p%26lt;0.001), and a reduced number of foot amputations (p=0.005) in comparison with a control group receiving usual medical care. An incremental cost-effectiveness ratio of $355 per quality-adjusted life year gained was estimated for intervention participants during the same time period. %26lt;br%26gt;Conclusions: A simulated clinical trial suggests that a community health worker led diabetes intervention is a cost-effective way to reduce diabetes-related complications for uninsured Mexican Americans during a 20-year horizon in comparison to usual medical care.

• 出版日期2014-12