Abstract
Background: Self-management is crucial to successful glycemic control in patients with diabetes, yet it requires patients to initiate and sustain complicated behavioral changes. Support programs can improve glycemic control, but may be expensive to implement. We report here an analysis of the costs of a successful telephone-based self-management support program delivered by lay health educators utilizing a municipal health department A1c registry, and relate them to near-term effectiveness. Methods: Costs of implementation were assessed by micro-costing of all resources used. Per-capita costs and cost-effectiveness ratios from the perspective of the service provider are estimated for net A1c reduction, and percentages of patients achieving A1c reductions of 0.5 and 1.0 percentage points. One-way sensitivity analyses of key cost elements, and a Monte Carlo sensitivity analysis are reported. Results: The telephone intervention was provided to 443 people at a net cost of $187.61 each. Each percentage point of net A1c reduction was achieved at a cost of $464.41. Labor costs were the largest component of costs, and cost-effectiveness was most sensitive to the wages paid to the health educators. Conclusions: Effective telephone-based self-management support for people in poor diabetes control can be delivered by health educators at moderate cost relative to the gains achieved. The costs of doing so are most sensitive to the prevailing wage for the health educators.
| Original language | English (US) |
|---|---|
| Journal | Journal of Diabetes and its Complications |
| DOIs | |
| State | Accepted/In press - Aug 26 2015 |
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Keywords
- Cost-effectiveness
- Diabetes
- HbA1c
- Health educators
- Telephone-based care
ASJC Scopus subject areas
- Endocrinology
- Endocrinology, Diabetes and Metabolism
- Internal Medicine
Cite this
Costs and effects of a telephonic diabetes self-management support intervention using health educators. / Schechter, Clyde B.; Walker, Elizabeth A.; Ortega, Felix M.; Chamany, Shadi; Silver, Lynn D.
In: Journal of Diabetes and its Complications, 26.08.2015.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Costs and effects of a telephonic diabetes self-management support intervention using health educators
AU - Schechter, Clyde B.
AU - Walker, Elizabeth A.
AU - Ortega, Felix M.
AU - Chamany, Shadi
AU - Silver, Lynn D.
PY - 2015/8/26
Y1 - 2015/8/26
N2 - Background: Self-management is crucial to successful glycemic control in patients with diabetes, yet it requires patients to initiate and sustain complicated behavioral changes. Support programs can improve glycemic control, but may be expensive to implement. We report here an analysis of the costs of a successful telephone-based self-management support program delivered by lay health educators utilizing a municipal health department A1c registry, and relate them to near-term effectiveness. Methods: Costs of implementation were assessed by micro-costing of all resources used. Per-capita costs and cost-effectiveness ratios from the perspective of the service provider are estimated for net A1c reduction, and percentages of patients achieving A1c reductions of 0.5 and 1.0 percentage points. One-way sensitivity analyses of key cost elements, and a Monte Carlo sensitivity analysis are reported. Results: The telephone intervention was provided to 443 people at a net cost of $187.61 each. Each percentage point of net A1c reduction was achieved at a cost of $464.41. Labor costs were the largest component of costs, and cost-effectiveness was most sensitive to the wages paid to the health educators. Conclusions: Effective telephone-based self-management support for people in poor diabetes control can be delivered by health educators at moderate cost relative to the gains achieved. The costs of doing so are most sensitive to the prevailing wage for the health educators.
AB - Background: Self-management is crucial to successful glycemic control in patients with diabetes, yet it requires patients to initiate and sustain complicated behavioral changes. Support programs can improve glycemic control, but may be expensive to implement. We report here an analysis of the costs of a successful telephone-based self-management support program delivered by lay health educators utilizing a municipal health department A1c registry, and relate them to near-term effectiveness. Methods: Costs of implementation were assessed by micro-costing of all resources used. Per-capita costs and cost-effectiveness ratios from the perspective of the service provider are estimated for net A1c reduction, and percentages of patients achieving A1c reductions of 0.5 and 1.0 percentage points. One-way sensitivity analyses of key cost elements, and a Monte Carlo sensitivity analysis are reported. Results: The telephone intervention was provided to 443 people at a net cost of $187.61 each. Each percentage point of net A1c reduction was achieved at a cost of $464.41. Labor costs were the largest component of costs, and cost-effectiveness was most sensitive to the wages paid to the health educators. Conclusions: Effective telephone-based self-management support for people in poor diabetes control can be delivered by health educators at moderate cost relative to the gains achieved. The costs of doing so are most sensitive to the prevailing wage for the health educators.
KW - Cost-effectiveness
KW - Diabetes
KW - HbA1c
KW - Health educators
KW - Telephone-based care
UR - http://www.scopus.com/inward/record.url?scp=84952012731&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84952012731&partnerID=8YFLogxK
U2 - 10.1016/j.jdiacomp.2015.11.017
DO - 10.1016/j.jdiacomp.2015.11.017
M3 - Article
JO - Journal of Diabetes and its Complications
JF - Journal of Diabetes and its Complications
SN - 1056-8727
ER -