title: Can chronic disease management programs for patients with type 2 diabetes reduce productivity-related indirect costs of the disease? Evidence from a randomized controlled trial.
abstract: The objective was to assess the impacts of diabetes self-management programs on productivity-related indirect costs of the disease. Using an employer's perspective, this study estimated the productivity losses associated with: (1) employee absence on the job, (2) diabetes-related disability, (3) employee presence on the job, and (4) early mortality. Data were obtained from electronic medical records and survey responses of 376 adults aged ≥18 years who were enrolled in a randomized controlled trial of type 2 diabetes self-management programs. All study participants had uncontrolled diabetes and were randomized into one of 4 study arms: personal digital assistant (PDA), chronic disease self-management program (CDSMP), combined PDA and CDSMP, and usual care (UC). The human-capital approach was used to estimate lost productivity resulting from 1, 2, 3, and 4 above, which are summed to obtain total productivity loss. Using robust regression, total productivity loss was modeled as a function of the diabetes self-management programs and other identified demographic and clinical characteristics. Compared to subjects in the UC arm, there were no statistically significant differences in productivity losses among persons undergoing any of the 3 diabetes management interventions. Males were associated with higher productivity losses (+$708/year; P<0.001) and persons with greater than high school education were associated with additional productivity losses (+$758/year; P<0.001). Persons with more than 1 comorbid condition were marginally associated with lower productivity losses (-$326/year; P=0.055). No evidence was found that the chronic disease management programs examined in this trial affect indirect productivity losses.
authors.affiliation: 1 Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center , College Station, Texas.
authors.forename: Omolola E
authors.initials: OE
authors.lastname: Adepoju
authors.forename: Jane N
authors.initials: JN
authors.lastname: Bolin
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ohsfeldt
authors.forename: Charles D
authors.initials: CD
authors.lastname: Phillips
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhao
authors.forename: Marcia G
authors.initials: MG
authors.lastname: Ory
authors.forename: Samuel N
authors.initials: SN
authors.lastname: Forjuoh
mesh_terms: D000041:Absenteeism; D000328:Adult; D000367:Age Factors; D002908:Chronic Disease; D015331:Cohort Studies; D016001:Confidence Intervals; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D019468:Disease Management; D004526:Efficiency; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012648:Self Care / Q000191:economics* / Q000379:methods; D012737:Sex Factors; D013781:Texas