title: The Community Diabetes Education (CoDE) program: cost-effectiveness and health outcomes.
abstract: BACKGROUND
  Limited evidence exists regarding the long-term effects of community health worker-led diabetes management programs on health outcomes and cost-effectiveness, particularly in low-income, ethnic minority populations.
  
  
  OBJECTIVE
  To examine the long-term cost-effectiveness and improvements in diabetes-related complications of a diabetes education and management intervention led by community health workers among uninsured Mexican Americans.
  
  
  METHODS
  Clinical data, changes in hemoglobin A1c over 12 months, and costs from an RCT of 180 uninsured Mexican Americans with type 2 diabetes conducted in 2006 were utilized for secondary analyses in 2012. Simulation modeling was used to estimate long-term cost and health outcomes using the validated Archimedes Model. The absolute differences for the incremental cost-effectiveness ratios and cumulative incidence of diabetes-related complications were derived by comparing intervention and control groups.
  
  
  RESULTS
  During a 20-year time horizon, participants who received the intervention would be expected to have significantly lower hemoglobin A1c levels (p<0.001), fewer foot ulcers (p<0.001), and a reduced number of foot amputations (p=0.005) in comparison with a control group receiving usual medical care. An incremental cost-effectiveness ratio of $355 per quality-adjusted life year gained was estimated for intervention participants during the same time period.
  
  
  CONCLUSIONS
  A simulated clinical trial suggests that a community health worker-led diabetes intervention is a cost-effective way to reduce diabetes-related complications for uninsured Mexican Americans during a 20-year horizon in comparison to usual medical care.
authors.affiliation: Department of Epidemiology, University of Texas Health Science Center, Dallas. Electronic address: eaprezio@sbcglobal.net.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Prezio
authors.affiliation: Center for Health Innovation, The New York Academy of Medicine, New York, New York; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: José A
authors.initials: JA
authors.lastname: Pagán
authors.affiliation: Intramural Research Department, Economics and Health Policy Research Program, American Cancer Society, Atlanta, Georgia.
authors.forename: Kerem
authors.initials: K
authors.lastname: Shuval
authors.affiliation: TMF Health Quality Institute, Austin, Texas.
authors.forename: Dan
authors.initials: D
authors.lastname: Culica
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000175:diagnosis / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006266:Health Education / Q000379:methods*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D017058:Mexican Americans / Q000193:education / Q000706:statistics & numerical data; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011203:Poverty; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000379:methods*; D014481:United States
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents