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Cost-effectiveness of financial incentives to improve glycemic control in adults with diabetes: A pilot randomized

Leonard E Egede1,2, Rebekah J Walker1,2, Clara E Dismuke-Greer3

  • 1Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America.

Plos One
|March 18, 2021
PubMed

Insights

Financial incentives can effectively reduce HbA1c in adults with type 2 diabetes. Multi-component incentives are cost-effective, showing the least variation in achieving a 1% HbA1c reduction.

Area of Science:

  • Diabetes Management
  • Health Economics
  • Behavioral Interventions

Background:

  • Type 2 diabetes requires effective management strategies to prevent complications.
  • Financial incentives are increasingly explored to improve patient adherence and clinical outcomes.
  • Understanding the cost-effectiveness of different incentive structures is crucial for public health.

Purpose of the Study:

  • To evaluate the cost-effectiveness of three distinct financial incentive structures.
  • To determine the cost per 1% reduction in HbA1c for each incentive group.
  • To assess the variability in cost-effectiveness across different incentive designs.

Main Methods:

  • Randomized controlled trial involving 60 African Americans with type 2 diabetes over 3 months.
  • Three incentive groups: low frequency (absolute HbA1c reduction), moderate frequency (home glucose testing and HbA1c reduction), and high frequency (home testing, education classes, and HbA1c reduction).
  • Cost analysis included intervention costs, healthcare visits, and missed workdays; Incremental Cost-Effectiveness Ratios (ICER) were calculated and bootstrapped.

Main Results:

  • The ICER to achieve a 1% HbA1c reduction was $1,100 across all three groups.
  • Groups 2 and 3 demonstrated statistically significant cost-effectiveness (p<0.001).
  • Group 1 showed twice the variation in ICER compared to Groups 2 and 3.

Conclusions:

  • A cost of $1,100 per 1% HbA1c decrease is a promising figure compared to prior diabetes interventions.
  • Multi-component financial incentive structures appear to be the most stable and cost-effective.
  • These findings support the use of structured, multi-component incentives for diabetes management.
Abstract

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