Cost-effectiveness of diabetes case management for low-income populations.
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.
Gilmer
Todd P
TP
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093-0622, USA.
Roze
Stéphane
S
Valentine
William J
WJ
Emy-Albrecht
Katrina
K
Ray
Joshua A
JA
Cobden
David
D
Nicklasson
Lars
L
Philis-Tsimikas
Athena
A
Palmer
Andrew J
AJ
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