Abstract
IntroductionThe objective of our study was to estimate the long-term cost-effectiveness of a lifestyle modification program led by community health workers (CHWs) for low-income Hispanic adults with type 2 diabetes.MethodsWe forecasted disease outcomes, quality-adjusted life years (QALYs) gained, and lifetime costs associated with attaining different hemoglobin A1c (A1c) levels. Outcomes were projected 20 years into the future and discounted at a 3.0% rate. Sensitivity analyses were conducted to assess the extent to which our results were dependent on assumptions related to program effectiveness, projected years, discount rates, and costs.ResultsThe incremental cost-effectiveness ratio of the intervention ranged from $10,995 to $33,319 per QALY gained when compared with usual care. The intervention was particularly cost-effective for adults with high glycemic levels (A1c > 9%). The results are robust to changes in multiple parameters.ConclusionThe CHW program was cost-effective. This study adds to the evidence that culturally sensitive lifestyle modification programs to control diabetes can be a cost-effective way to improve health among Hispanics with diabetes, particularly among those with high A1c levels.
Highlights
The objective of our study was to estimate the long-term cost-effectiveness of a lifestyle modification program led by community health workers (CHWs) for low-income Hispanic adults with type 2 diabetes
This study adds to the evidence that culturally sensitive lifestyle modification programs to control diabetes can be a cost-effective way to improve health among Hispanics with diabetes, among those with high A1c levels
The effects of the University of Texas Community Outreach (UTCO) intervention are reflected in clinical outcomes for a cohort of participants whose A1c levels at the beginning of the intervention were above 7%, but fell to 7% or below during the course of the 18-month intervention (Table 3)
Summary
The objective of our study was to estimate the long-term cost-effectiveness of a lifestyle modification program led by community health workers (CHWs) for low-income Hispanic adults with type 2 diabetes. The Hispanic paradox – that Hispanics have greater life expectancy than their non-Hispanic counterparts – is well-documented [3], Hispanics are disproportionately affected by diabetes [4,5]. The prevalence of diabetes in US adult Hispanics is 13.3% compared with 7.1% for non-Hispanic whites [6]. Hispanics are 1.5 times more likely to die from diabetes than their non-Hispanic white counterparts [9]. Reasons cited for these disparities include less access to diabetesspecific care, language barriers, beliefs about diabetes, and health insurance coverage status [7]
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