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Cost-Effectiveness of Technology-Assisted Case Management in Low-Income, Rural Adults with Type 2 Diabetes.
Leonard E Egede1,2, Clara E Dismuke3, Rebekah J Walker1,2
1Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Health Equity
|July 30, 2021
Summary
Technology-assisted case management (TACM) is a cost-effective option for managing type 2 diabetes in rural adults. This intervention helps reduce hemoglobin A1c levels, improving patient outcomes.
Area of Science:
- Health Services Research
- Diabetes Management
- Health Economics
Background:
- Type 2 diabetes disproportionately affects low-income, rural populations.
- Effective management of type 2 diabetes is crucial for preventing long-term complications.
- Access to consistent, quality healthcare can be a challenge in rural settings.
Purpose of the Study:
- To evaluate the cost-effectiveness of technology-assisted case management (TACM) for type 2 diabetes.
- To compare TACM with usual care in low-income, rural adults.
- To assess the impact of TACM on hemoglobin A1c (HbA1c) levels and associated costs.
Main Methods:
- Randomized controlled trial involving 113 low-income, rural adults with type 2 diabetes and HbA1c ≥8%.
- Intervention group received TACM with nurse-led medication titration under physician supervision.
- Control group received usual care (standard office procedures).
- Effectiveness measured by HbA1c differences at 6 months; cost analysis included intervention, medical care, and lost income.
Main Results:
- The TACM intervention resulted in statistically significant cost differences compared to usual care ($5,379.60 vs. $1,360.49).
- The median bootstrapped incremental cost-effectiveness ratio (ICER) was $6,299.04 per 1% decrease in HbA1c.
- TACM demonstrated a cost-effectiveness of approximately $6,300 for a 1% reduction in HbA1c.
Conclusions:
- TACM is a cost-effective strategy for improving glycemic control in vulnerable populations with type 2 diabetes.
- The intervention offers a viable option for enhancing diabetes care in rural, low-income settings.
- Further research may explore long-term outcomes and scalability of TACM.
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