Cost-effectiveness of a diabetes group education program delivered by health promoters with a guiding style in underserved communities in Cape Town, South Africa.
Posted on 05 November 2015
Summary of findings
In South Africa, a diabetes group education program delivered by health promoters to improve management of diabetes was cost effective for management of patient type 2 diabetes in long term. The initial cost of the intervention is offset by the savings from reduction in long term medical expenses such as hospitalizations and secondary prevention care.
Group education program/ 4 hours session of at least 60 min. Session delivered by a health promoter. Patients were expected to attend the session on monthly basis. Patients were reminded about the sessions by a text message.
Four scenario tested:
- Intervention repeated each year and the benefit persist over time
- Intervention is performed once and the benefit only occur in that year
- Intervention is performed once, the benefit persist indefinitely assuming that the behavior is fully adopted by the patients
- Intervention is performed once; the benefit is gradually decreased over three years.
Usual care (no intervention)
Type 2 diabetes
Country of the study
Source of effectiveness
Pragmatic clustered randomized controlled trial.
Instrument for utility measure
Quality adjusted life years (QALYs)
Type of cost
Cost of intervention and cost of long term health care due to cardiovascular disease, in particular stroke and ischemic heart disease.
Source of cost
Cost collected during the RCTs. Interviews were held with the health promoters, facility managers, district level financial officers and managers to ensure no treatment cost were missed.
Markov micro-simulation model (developed using South African datasets)
ICER (incremental cost-effectiveness ratio)
Scenario 1. Annual cost, persistent benefit ICER = 1862 $/QALY
Scenario 2. One year cost, persistent benefit: ICER = dominant
Scenario 3. One year cost, one year benefit : ICER = dominant
Scenario 4. One year cost, three year declining benefit: ICER = dominant
Source of research funding
BRIDGES grant from the International Diabetes Federation. BRIDGES is an IDF project supported by an educational grant from Lilly diabetes.
Mash R, Kroukamp R, Gaziano T, Levitt N. Cost-effectiveness of a diabetes group education program delivered by health promoters with a guiding style in underserved communities in Cape Town, South Africa. Patient Educ Couns. 2015 May;98(5):622-6.