title: Costs and effects of a telephonic diabetes self-management support intervention using health educators.
abstract: BACKGROUND
  Self-management is crucial to successful glycemic control in patients with diabetes, yet it requires patients to initiate and sustain complicated behavioral changes. Support programs can improve glycemic control, but may be expensive to implement. We report here an analysis of the costs of a successful telephone-based self-management support program delivered by lay health educators utilizing a municipal health department A1c registry, and relate them to near-term effectiveness.
  
  
  METHODS
  Costs of implementation were assessed by micro-costing of all resources used. Per-capita costs and cost-effectiveness ratios from the perspective of the service provider are estimated for net A1c reduction, and percentages of patients achieving A1c reductions of 0.5 and 1.0 percentage points. One-way sensitivity analyses of key cost elements, and a Monte Carlo sensitivity analysis are reported.
  
  
  RESULTS
  The telephone intervention was provided to 443 people at a net cost of $187.61 each. Each percentage point of net A1c reduction was achieved at a cost of $464.41. Labor costs were the largest component of costs, and cost-effectiveness was most sensitive to the wages paid to the health educators.
  
  
  CONCLUSIONS
  Effective telephone-based self-management support for people in poor diabetes control can be delivered by health educators at moderate cost relative to the gains achieved. The costs of doing so are most sensitive to the prevailing wage for the health educators.
authors.affiliation: Albert Einstein College of Medicine, USA. Electronic address: clyde.schechter@einstein.yu.edu.
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.affiliation: Albert Einstein College of Medicine, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Walker
authors.affiliation: New York City Department of Health and Mental Hygiene, USA.
authors.forename: Felix M
authors.initials: FM
authors.lastname: Ortega
authors.affiliation: New York City Department of Health and Mental Hygiene, USA.
authors.forename: Shadi
authors.initials: S
authors.lastname: Chamany
authors.affiliation: New York City Department of Health and Mental Hygiene, USA.
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Silver
mesh_terms: D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D037001:Directive Counseling / Q000191:economics; D017048:Health Care Costs; D040441:Health Educators / Q000191:economics; D006801:Humans; D010353:Patient Education as Topic / Q000191:economics; D012456:Salaries and Fringe Benefits; D012648:Self Care / Q000191:economics / Q000592:standards; D012944:Social Support; D017216:Telemedicine / Q000191:economics / Q000379:methods; D013689:Telephone / Q000191:economics
keywords: HbA1c; cost-effectiveness; diabetes; health educators; telephone-based care