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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.

Intervention(S)

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.

Comparator (S)

Usual care (no intervention)

Disease classification

Type 2 diabetes

Country of the study

South Africa

Perspective

Societal perspective

Time horizon

30 years

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.

Currency

US dollar

Modeling approach

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.

References

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.