Cost-effectiveness analysis of a community health worker intervention for low-income Hispanic adults with diabetes.
BACKGROUND
The 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.


METHODS
We 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.


RESULTS
The 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.


CONCLUSIONS
The 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.
University of Texas Health Science Center School of Public Health, Austin, TX 78701, USA.
H Shelton
HS
Brown
Kimberly J
KJ
Wilson
José A
JA
Pagán
Christine M
CM
Arcari
Martha
M
Martinez
Kirk
K
Smith
Belinda
B
Reininger
D000293:Adolescent; D000328:Adult; D003150:Community Health Workers / Q000191:economics*; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000628:therapy; D005260:Female; D006293:Health Promotion / Q000191:economics*; D006295:Health Resources / Q000191:economics; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics; D011203:Poverty / Q000208:ethnology; D016730:Program Development; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000191:economics; D012959:Socioeconomic Factors; D013781:Texas