title: Cost-effectiveness of a diabetes group education program delivered by health promoters with a guiding style in underserved communities in Cape Town, South Africa.
abstract: OBJECTIVE
  This study aimed to evaluate the cost-effectiveness of a group diabetes education program delivered by health promoters in community health centers in the Western Cape, South Africa.
  
  
  METHODS
  The effectiveness of the education program was derived from the outcomes of a pragmatic cluster randomized controlled trial (RCT). Incremental operational costs of the intervention, as implemented in the trial, were calculated. All these data were entered into a Markov micro-simulation model to simulate clinical outcomes and health costs that were expressed as an Incremental Cost Effectiveness Ratio (ICER).
  
  
  RESULTS
  The only significant effect from the RCT at one year was a reduction in blood pressure (systolic blood pressure -4.65 mmHg (95%CI:-9.18 to -0.12) and diastolic blood pressure -3.30 mmHg (95%CI:-5.35 to -1.26)). The ICER for the intervention, based on the assumption that the costs would recur every year and the effect could be maintained, was 1862 $/QALY gained.
  
  
  CONCLUSIONS
  A structured group education program performed by mid-level trained healthcare workers at community health centers, for the management of Type II diabetes in the Western Cape, South Africa is therefore cost-effective.
  
  
  CONCLUSIONS
  This cost-effectiveness analysis supports the more widespread implementation of this intervention in primary care within South Africa.
authors: Division of Family Medicine and Primary Care, Stellenbosch University, Box 19063, Tygerberg, 7505, South Africa. Electronic address: rm@sun.ac.za.
authors: Robert
authors: R
authors: Mash
authors: Division of Family Medicine and Primary Care, Stellenbosch University, Box 19063, Tygerberg, 7505, South Africa. Electronic address: kroukamproland4@gmail.com.
authors: Roland
authors: R
authors: Kroukamp
authors: Division of Social Medicine and Health Inequalities, Brigham & Women's Hospital, Harvard Medical School, USA. Electronic address: tgaziano@partners.org.
authors: Tom
authors: T
authors: Gaziano
authors: Division of Diabetic Medicine and Endocrinology, University of Cape Town and Chronic Diseases Initiative for Africa, South Africa. Electronic address: naomi.levitt@uct.ac.za.
authors: Naomi
authors: N
authors: Levitt
mesh_terms: D000328:Adult; D003151:Community Health Centers; D003150:Community Health Workers; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000523:psychology / Q000628:therapy*; D006126:Group Processes; D006266:Health Education / Q000191:economics*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000191:economics* / Q000379:methods*; D015397:Program Evaluation; D011788:Quality of Life; D012648:Self Care; D020377:Self Efficacy; D013019:South Africa; D015431:Weight Loss
keywords: Cost-effectiveness; Diabetes; Group education; Mid-level health workers; Motivational interviewing; Non-communicable chronic diseases; Patient education; Primary care