Ontology highlight
ABSTRACT: Objective
To evaluate the cost-effectiveness of Project Dulce, a culturally specific diabetes case management and self-management training program, in four cohorts defined by insurance status.Data sources/study setting
Clinical and cost data on 3,893 persons with diabetes participating in Project Dulce were used as inputs into a diabetes simulation model.Study design
The Center for Outcomes Research Diabetes Model, a published, peer-reviewed and validated simulation model of diabetes, was used to evaluate life expectancy, quality-adjusted life expectancy (QALY), cumulative incidence of complications and direct medical costs over patient lifetimes (40-year time horizon) from a third-party payer perspective. Cohort characteristics, treatment effects, and case management costs were derived using a difference in difference design comparing data from the Project Dulce program to a cohort of historical controls. Long-term costs were derived from published U.S. sources. Costs and clinical benefits were discounted at 3.0 percent per annum. Sensitivity analyses were performed.Principal findings
Incremental cost-effectiveness ratios of $10,141, $24,584, $44,941, and $69,587 per QALY gained were estimated for Project Dulce participants versus control in the uninsured, County Medical Services, Medi-Cal, and commercial insurance cohorts, respectively.Conclusions
The Project Dulce diabetes case management program was associated with cost-effective improvements in quality-adjusted life expectancy and decreased incidence of diabetes-related complications over patient lifetimes. Diabetes case management may be particularly cost effective for low-income populations.
SUBMITTER: Gilmer TP
PROVIDER: S-EPMC2254564 | biostudies-literature | 2007 Oct
REPOSITORIES: biostudies-literature
Gilmer Todd P TP Roze Stéphane S Valentine William J WJ Emy-Albrecht Katrina K Ray Joshua A JA Cobden David D Nicklasson Lars L Philis-Tsimikas Athena A Palmer Andrew J AJ
Health services research 20071001 5
<h4>Objective</h4>To evaluate the cost-effectiveness of Project Dulce, a culturally specific diabetes case management and self-management training program, in four cohorts defined by insurance status.<h4>Data sources/study setting</h4>Clinical and cost data on 3,893 persons with diabetes participating in Project Dulce were used as inputs into a diabetes simulation model.<h4>Study design</h4>The Center for Outcomes Research Diabetes Model, a published, peer-reviewed and validated simulation model ...[more]