Cost-effectiveness analysis of a cluster-randomized, culturally tailored, community health worker home-visiting diabetes intervention versus standard care in American Samoa
Cost-effectiveness analysis of a cluster-randomized, culturally tailored, community health worker home-visiting diabetes intervention versus standard care in American Samoa
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DOI：
10.1186/s12960-019-0356-6
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发表时间：
2019-03-05
影响因子：
4.5
通讯作者：
McGarvey, Stephen T.
中科院分区：
文献类型：
--
作者：
Huang, Shuo J.;Galarraga, Omar;McGarvey, Stephen T.
背景2型糖尿病（T2 DM）在美属萨摩亚非常普遍。社区卫生工作者（CHW）的干预措施可能会改善T2 DM护理，并具有成本效益。目前的成本效益分析（CEA）的CHW干预措施，要么忽视了重要的成本考虑或不基于随机临床试验（RCT）。2009-2010年发生的美属萨摩亚糖尿病护理（DCAS）干预是一种随机分组、文化定制、家访CHW干预和改善HbA 1c水平的干预，目的分析在低资源环境中使用RCT的DCAS干预对标准护理的成本效益。2年的成本数据和基于RCT糖化血红蛋白（HbA 1c）改善的质量调整生命年（Qs）模型。我们计算了增量成本效益比（ICER）从社会的角度来看，在2年的时间范围内，并报告了2012年美元（$）的所有成本。CHW组的HbA 1c平均降低0.53%，成本增加594美元，增加0.05个季度。CHW臂的ICER相比，控制臂是1121美元每百分点HbA 1c减少和13191美元每QALY gained.ConclusionsCompared各种愿意支付阈值从39000美元到154353美元每QALY获得，这ICER表明，CHW干预是具有很高的成本效益。未来在类似环境中对CHW T2 DM干预措施的成本效益进行的研究应模拟终身成本和获得的QDLS，以更好地评估长期成本效益。registrationClinicalTrials.gov 2009年2月9日注册，https：clinicaltrials.gov/ct2/show/NCT00850824。
BackgroundType 2 diabetes mellitus (T2DM) is highly prevalent in American Samoa. Community health worker (CHW) interventions may improve T2DM care and be cost-effective. Current cost-effectiveness analyses (CEA) of CHW interventions have either overlooked important cost considerations or not been based on randomized clinical trials (RCTs). The Diabetes Care in American Samoa (DCAS) intervention which occurred in 2009-2010 was a cluster-randomized, culturally tailored, home-visiting CHW intervention and improved HbA1c levels.ObjectiveTo analyze the cost-effectiveness of the DCAS intervention against standard care using a RCT in a low-resource setting.MethodsWe collected clinical, utilization, and cost data over 2years and modeled quality-adjusted life years (QALYs) gained based on the RCT glycated hemoglobin (HbA1c) improvements. We calculated an incremental cost-effectiveness ratio (ICER) from the societal perspective over a 2-year time horizon and reported all costs in 2012 USD ($).ResultsTwo hundred sixty-eight American Samoans diagnosed with T2DM were cluster randomized into the CHW (n=104) or standard care control (n=164) arms. The CHW arm had a mean reduction of 0.53% in HbA1c, an increase of $594 in cost, and an increase of 0.05 QALYs. The ICER for the CHW arm compared to the control arm was $1121 per percentage point HbA1c reduced and $13191 per QALY gained.ConclusionsCompared to a variety of willingness-to-pay thresholds from $39000 to $154353 per QALY gained, this ICER shows that the CHW intervention is highly cost-effective. Future studies of the cost-effectiveness of CHW T2DM interventions in similar settings should model lifetime costs and QALYs gained to better assess long-term cost-effectiveness.Trial registrationClinicalTrials.gov, ID NCT00850824. Registered 9 February 2009,https://clinicaltrials.gov/ct2/show/NCT00850824.