Cost-effectiveness of a diabetes group education program delivered by health promoters with a guiding style in underserved communities in Cape Town, South Africa
Cost-effectiveness of a diabetes group education program delivered by health promoters with a guiding style in underserved communities in Cape Town, South Africa
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DOI：
10.1016/j.pec.2015.01.005
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发表时间：
2015-05-01
影响因子：
3.5
通讯作者：
Levitt, Naomi
中科院分区：
文献类型：
--
作者：
Mash, Robert;Kroukamp, Roland;Levitt, Naomi
目的：本研究旨在评价健康促进者在南非西开普省社区卫生中心开展的团体糖尿病教育项目的成本-效果。方法：教育项目的有效性来自于一项实用的整群随机对照试验(RCT)的结果。计算了试验中实施的干预措施的增量运营成本。所有这些数据被输入到马尔可夫微模拟模型中，以模拟临床结果和医疗成本，并以增量成本效益比(ICER)表示。结果：RCT在一年内唯一显著的效果是血压下降(收缩压-4.65 mm Hg(95%CI：-9.18至-0.12)，舒张压-3.30 mm Hg(95%CI：-5.35至-1.26))。基于成本每年都会重复并且效果可以维持的假设，干预的ICER为1862美元/QALY。结论：在南非西开普省，由训练有素的中层医务人员在社区卫生中心开展结构化的团体教育项目，用于管理II型糖尿病，因此是具有成本效益的。实践影响：这一成本-效果分析支持在南非的初级保健中更广泛地实施这种干预。(C)2015年提交人。由爱思唯尔爱尔兰有限公司出版。这是CC BY-NC-ND许可证(http://creativecommons.org/licenses/by-nc-nd/4.0/).下的一篇开放获取文章
Objective: This study aimed to evaluate the cost-effectiveness of a group diabetes education program delivered by health promoters in community health centers in the Western Cape, South Africa.Methods: The effectiveness of the education program was derived from the outcomes of a pragmatic cluster randomized controlled trial (RCT). Incremental operational costs of the intervention, as implemented in the trial, were calculated. All these data were entered into a Markov micro-simulation model to simulate clinical outcomes and health costs that were expressed as an Incremental Cost Effectiveness Ratio (ICER).Results: The only significant effect from the RCT at one year was a reduction in blood pressure (systolic blood pressure -4.65 mmHg (95%CI: -9.18 to -0.12) and diastolic blood pressure -3.30 mmHg (95%CI: -5.35 to -1.26)). The ICER for the intervention, based on the assumption that the costs would recur every year and the effect could be maintained, was 1862 $/QALY gained.Conclusion: A structured group education program performed by mid-level trained healthcare workers at community health centers, for the management of Type II diabetes in the Western Cape, South Africa is therefore cost-effective.Practice implications: This cost-effectiveness analysis supports the more widespread implementation of this intervention in primary care within South Africa. (C) 2015 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).