Cost-effectiveness of diabetes case management for low-income populations
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Gilmer, TP and Roze, S and Valentine, WJ and Emy-Albrecht, K and Ray, JA and Cobden, D and Nicklasson, L and Philis-Tsimikas, A and Palmer, AJ, Cost-effectiveness of diabetes case management for low-income populations, Health Services Research, 42, (5) pp. 1943-1959. ISSN 0017-9124 (2007) [Refereed Article]
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. © 2007 Health Research and Educational Trust.
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