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Cost-effectiveness of diabetes case management for low-income populations.


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

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Publications

Cost-effectiveness of diabetes case management for low-income populations.

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]

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