Cost-Effectiveness of a Diabetes Self-Management Education and Support Intervention Led by Community Health Workers and Peer Leaders: Projections From the Racial and Ethnic Approaches to Community Health Detroit Trial

Abstract

<b>Objective: </b>To simulate the long-term cost-effectiveness of a peer-leader (PL)-led diabetes self-management support (DSMS) program following a structured community health worker (CHW)-led diabetes self-management education (DSME) program, in reducing risks of complications in people with type 2 diabetes (T2DM). <p> </p> <p><b>Research Design and Methods: </b>The trial randomized 222 Latino adults with T2DM to 1) enhanced usual care (EUC), 2) a CHW-led, 6-month DSME program and 6 months of CHW delivered monthly telephone outreach (CHW-only), or 3) a CHW-led, 6-month DSME program and 12 months of PLs-delivered weekly group sessions with telephone outreach to those unable to attend (CHW+PL). Empirical data from the trial and the validated Michigan Model for Diabetes were used to estimate cost and health outcomes over a 20-year time horizon from a healthcare sector perspective, discounting both costs and benefits at 3% annually. The primary outcome measure was the incremental cost-effectiveness ratio (ICER).</p> <p> </p> <p><b>Results: </b>Over 20 years, the CHW+PL intervention had an ICER of $28,800 and $5,900 per quality adjusted life year (QALY) gained compared to the EUC and CHW-only interventions, respectively. The CHW-only intervention had an ICER of $430,600 per QALY gained compared to the EUC intervention. In sensitivity analyses, the results comparing the CHW+PL to EUC and CHW-only interventions were robust to changes in intervention effects and costs.</p> <p> </p> <p><b>Conclusions:</b> The CHW+PL-led DSME/DSMS intervention improved health and provided good value compared to the EUC intervention. The 6-month CHW-led DSME intervention without further post-intervention CHW support was not cost-effective in Latino adults with T2DM. </p>