title: Cost-effectiveness of diabetes case management for low-income populations.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of Project Dulce, a culturally specific diabetes case management and self-management training program, in four cohorts defined by insurance status.
  
  
  METHODS
  Clinical and cost data on 3,893 persons with diabetes participating in Project Dulce were used as inputs into a diabetes simulation model.
  
  
  METHODS
  The Center for Outcomes Research Diabetes Model, a published, peer-reviewed and validated simulation model of diabetes, was used to evaluate life expectancy, quality-adjusted life expectancy (QALY), cumulative incidence of complications and direct medical costs over patient lifetimes (40-year time horizon) from a third-party payer perspective. Cohort characteristics, treatment effects, and case management costs were derived using a difference in difference design comparing data from the Project Dulce program to a cohort of historical controls. Long-term costs were derived from published U.S. sources. Costs and clinical benefits were discounted at 3.0 percent per annum. Sensitivity analyses were performed.
  
  
  RESULTS
  Incremental cost-effectiveness ratios of $10,141, $24,584, $44,941, and $69,587 per QALY gained were estimated for Project Dulce participants versus control in the uninsured, County Medical Services, Medi-Cal, and commercial insurance cohorts, respectively.
  
  
  CONCLUSIONS
  The Project Dulce diabetes case management program was associated with cost-effective improvements in quality-adjusted life expectancy and decreased incidence of diabetes-related complications over patient lifetimes. Diabetes case management may be particularly cost effective for low-income populations.
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093-0622, USA.
authors.forename: Todd P
authors.initials: TP
authors.lastname: Gilmer
authors.forename: Stéphane
authors.initials: S
authors.lastname: Roze
authors.forename: William J
authors.initials: WJ
authors.lastname: Valentine
authors.forename: Katrina
authors.initials: K
authors.lastname: Emy-Albrecht
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Ray
authors.forename: David
authors.initials: D
authors.lastname: Cobden
authors.forename: Lars
authors.initials: L
authors.lastname: Nicklasson
authors.forename: Athena
authors.initials: A
authors.lastname: Philis-Tsimikas
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Palmer
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D019090:Case Management / Q000191:economics*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D018864:Cultural Diversity; D003920:Diabetes Mellitus / Q000191:economics*; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011203:Poverty; D015397:Program Evaluation; D012648:Self Care / Q000191:economics