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The Community Diabetes Education (CoDE) program: cost-effectiveness and health outcomes
Elizabeth A Prezio1, José A Pagán2, Kerem Shuval3
1Department of Epidemiology, University of Texas Health Science Center, Dallas.
American Journal of Preventive Medicine
|December 3, 2014
Summary
Community health worker diabetes management programs improve health and reduce complications for uninsured Mexican Americans. This intervention is cost-effective over 20 years, offering significant benefits compared to usual care.
Area of Science:
- Public Health
- Health Economics
- Diabetes Management
Background:
- Limited data on long-term effectiveness of community health worker (CHW) led diabetes programs in low-income, minority populations.
- Need for cost-effectiveness analysis of CHW interventions for diabetes.
Purpose of the Study:
- To assess long-term cost-effectiveness of a CHW-led diabetes management program.
- To evaluate improvements in diabetes-related complications for uninsured Mexican Americans.
Main Methods:
- Secondary analysis of RCT data (180 uninsured Mexican Americans with type 2 diabetes).
- Utilized 12-month clinical data (hemoglobin A1c) and costs.
- Employed Archimedes Model for 20-year simulation of cost and health outcomes.
- Calculated incremental cost-effectiveness ratios and complication incidence.
Main Results:
- Intervention group showed significantly lower hemoglobin A1c (p<0.001).
- Reduced incidence of foot ulcers (p<0.001) and amputations (p=0.005) over 20 years.
- Estimated incremental cost-effectiveness ratio of $355 per quality-adjusted life year gained.
Conclusions:
- CHW-led diabetes intervention is cost-effective for uninsured Mexican Americans.
- The program significantly reduces diabetes complications over a 20-year period.
- Offers a valuable alternative to usual medical care for this population.
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