title: Delivering Diabetes Education through Nurse-Led Telecoaching. Cost-Effectiveness Analysis.
abstract: BACKGROUND
  People with diabetes have a high risk of developing micro- and macrovascular complications associated with diminished life expectancy and elevated treatment costs. Patient education programs can improve diabetes control in the short term, but their cost-effectiveness is uncertain. Our study aimed to analyze the lifelong cost-effectiveness of a nurse-led telecoaching program compared to usual care in people with type 2 diabetes from the perspective of the Belgian healthcare system.
  
  
  METHODS
  The UKPDS Outcomes Model was populated with patient-level data from an 18-month randomized clinical trial in the Belgian primary care sector involving 574 participants; trial data were extrapolated to 40 years; Quality Adjusted Life Years (QALYs), treatment costs and Incremental Cost-Effectiveness Ratio (ICER) were calculated for the entire cohort and the subgroup with poor glycemic control at baseline ("elevated HbA1c subgroup") and the associated uncertainty was explored.
  
  
  RESULTS
  The cumulative mean QALY (95% CI) gain was 0.21 (0.13; 0.28) overall and 0.56 (0.43; 0.68) in elevated HbA1c subgroup; the respective incremental costs were €1,147 (188; 2,107) and €2,565 (654; 4,474) and the respective ICERs €5,569 (€677; €15,679) and €4,615 (1,207; 9,969) per QALY. In the scenario analysis, repeating the intervention for lifetime had the greatest impact on the cost-effectiveness and resulted in the mean ICERs of €13,034 in the entire cohort and €7,858 in the elevated HbA1c subgroup.
  
  
  CONCLUSIONS
  Taking into account reimbursement thresholds applied in West-European countries, nurse-led telecoaching of people with type 2 diabetes may be considered highly cost-effective within the Belgian healthcare system.
  
  
  BACKGROUND
  NCT01612520.
authors.affiliation: Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.
authors.forename: Irina
authors.initials: I
authors.lastname: Odnoletkova
authors.affiliation: Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Ramaekers
authors.affiliation: Department of Endocrinology, OLV Hospital Aalst, Aalst, Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: Nobels
authors.affiliation: Academic Center for General Practice, KU Leuven, Leuven, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Goderis
authors.affiliation: Academic Center for General Practice, KU Leuven, Leuven, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Aertgeerts
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose; D003362:Cost-Benefit Analysis; D003376:Counseling; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000517:prevention & control; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008019:Life Style; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D010353:Patient Education as Topic; D011320:Primary Health Care; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D013689:Telephone; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin