Cost-effectiveness of Telephone-Delivered Education and Behavioral Skills Intervention for African American Adults with Diabetes

Abstract

Purpose: Evaluate cost-effectiveness of a telephone-delivered education and behav­ioral skills intervention in reducing glycemic control (HbA1c) and decreasing risk of complications.Methods: Data from a randomized con­trolled trial, conducted from August 1, 2008 – June 30, 2010 and using a 2x2 factorial design delivered to 255 African American adults not meeting glycemic targets for dia­betes were used. Though the primary aim found no significant differences in HbA1c between groups, there was an overall drop in HbA1c across arms and differential cost. Primary clinical outcome was HbA1c measured at 12-months. Costs were esti­mated based on self-reported utilization of primary care, emergency, and other health care. Costs due to lost wages were calcu­lated based on self-reported days of work missed due to illness. The Michigan Model for Diabetes was used to estimate 10-year probability of developing congestive heart failure, cardiovascular disease, end stage renal disease, stroke, myocardial infarction, all cause death, and CVD death. Total cost per patient and clinical outcomes were used to estimate an incremental cost effective­ness ratio (ICER) using non-parametric bootstrapping.Results: ICERs indicated combined educa­tion and skills intervention was $3,630 less expensive than usual care to achieve a 0.6% decrease in HbA1c and was between $34,000 and $95,000 less expensive than usual care to reduce risk of complications. The knowledge only intervention was $661 less expensive than usual care and the behavioral skills only intervention did not indicate cost effectiveness.Conclusion: The combined intervention ICER for HbA1c is comparable to other education programs and the ICER to reduce the probability of complications falls below previously recommended long-term cut-off of $100,000, suggesting cost-effectiveness in an African American population.Ethn Dis. 2021;31(2):217-226; doi:10.18865/ed.31.2.217