Cost-Effectiveness Analysis of a Community Health Worker Intervention for Low-Income Hispanic Adults with Diabetes
Cost-Effectiveness Analysis of a Community Health Worker Intervention for Low-Income Hispanic Adults with Diabetes
复制标题
DOI：
10.5888/pcd9.120074
复制
发表时间：
2012-08-01
影响因子：
5.5
通讯作者：
Reininger, Belinda
中科院分区：
文献类型：
--
作者：
Brown, H. Shelton, III;Wilson, Kimberly J.;Reininger, Belinda
本研究的目的是评估由社区卫生工作者(CHWS)领导的生活方式改变计划对患有2型糖尿病的低收入西班牙裔成年人的长期成本效益。方法我们预测了与达到不同水平的血红蛋白A1c(A1c)相关的疾病结局、获得的质量调整寿命年(QALY)和终生成本。对未来20年的结果进行了预测，并以3.0%的比率贴现。我们进行了敏感性分析，以评估我们的结果在多大程度上依赖于与计划有效性、预计年限、贴现率和成本相关的假设。结果与通常的治疗相比，干预措施的每QALY增加的成本-效果比在10,995美元到33,319美元之间。对于血糖水平较高的成年人(A1c>；9%)，该干预措施的成本效益尤其高。结论CHW方案具有较高的成本效益。这项研究进一步证明，控制糖尿病的文化敏感的生活方式调整计划可能是改善患有糖尿病的拉美裔人健康的一种具有成本效益的方式，特别是在那些A1c水平较高的人中。
IntroductionThe objective of our study was to estimate the long-term cost-effectiveness of a lifestyle modification program led by community health workers (CHWs) for low-income Hispanic adults with type 2 diabetes.MethodsWe forecasted disease outcomes, quality-adjusted life years (QALYs) gained, and lifetime costs associated with attaining different hemoglobin A1c (A1c) levels. Outcomes were projected 20 years into the future and discounted at a 3.0% rate. Sensitivity analyses were conducted to assess the extent to which our results were dependent on assumptions related to program effectiveness, projected years, discount rates, and costs.ResultsThe incremental cost-effectiveness ratio of the intervention ranged from $10,995 to $33,319 per QALY gained when compared with usual care. The intervention was particularly cost-effective for adults with high glycemic levels (A1c > 9%). The results are robust to changes in multiple parameters.ConclusionThe CHW program was cost-effective. This study adds to the evidence that culturally sensitive lifestyle modification programs to control diabetes can be a cost-effective way to improve health among Hispanics with diabetes, particularly among those with high A1c levels.