title: Economic evaluation of chronic disease self-management for people with diabetes: a systematic review.
abstract: To systematically review the evidence on the costs and cost-effectiveness of self-management support interventions for people with diabetes.
  
  
  
  Self-management support is the provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, potentially leading to improvements in HbA1clevels in people with diabetes.
  
  
  
  Randomized controlled trials, observational studies or economic modelling studies were eligible for inclusion in the review. The target population was adults with diabetes. Interventions had to have a substantial component of self-management support and be compared with routine care. Study quality was evaluated using the Consensus on Health Economic Criteria and International Society of Pharmacoeconomic Outcomes Research questionnaires. A narrative review approach was used.
  
  
  
  A total of 16 costing and 21 cost-effectiveness studies of a range of self-management support interventions were identified. There was reasonably consistent evidence across 22 studies evaluating education self-management support programmes suggesting these interventions are cost-effective or superior to usual care. Telemedicine-type interventions were more expensive than usual care and potentially not cost-effective. There was insufficient evidence regarding the other types of self-management interventions, including pharmacist-led and behavioural interventions. The identified studies were predominantly of poor quality, with outcomes based on short-term follow-up data and study designs at high risk of bias.
  
  
  
  Self-management support education programmes may be cost-effective. There was limited evidence regarding other formats of self-management support interventions. The poor quality of many of the studies undermines the evidence base regarding the economic efficiency of self-management support interventions for people with diabetes.
authors: Health Information and Quality Authority, Dublin, Ireland.|Department of Public Health and Primary Care, Trinity College, Dublin, Ireland.
authors: C
authors: C
authors: Teljeur
authors: Health Information and Quality Authority, Dublin, Ireland.
authors: P S
authors: PS
authors: Moran
authors: Health Information and Quality Authority, Dublin, Ireland.
authors: S
authors: S
authors: Walshe
authors: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors: S M
authors: SM
authors: Smith
authors: Department of Public Health, Health Service Executive, Dublin, Ireland.
authors: F
authors: F
authors: Cianci
authors: Health Information and Quality Authority, Dublin, Ireland.
authors: L
authors: L
authors: Murphy
authors: Health Information and Quality Authority, Dublin, Ireland.
authors: P
authors: P
authors: Harrington
authors: Health Information and Quality Authority, Dublin, Ireland.
authors: M
authors: M
authors: Ryan
mesh_terms: D003131:Combined Modality Therapy / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000191:economics / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000191:economics / Q000628:therapy*; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics; D000073278:Self-Management / Q000191:economics / Q000193:education; D017216:Telemedicine / Q000191:economics