title: Cost-Effectiveness of Behavior Activation Versus Supportive Therapy on Adherence to Eye Exams in Older African Americans With Diabetes.
abstract: Although the importance of ophthalmologic screening in diabetic patients is widely recognized by clinicians, the cost-effectiveness of strategies aimed at improving eye care utilization in this population is not well established. A cost-effectiveness analysis was performed comparing behavior activation (BA) to supportive therapy (ST) in activating patients to receive a dilated fundus exam (DFE) and promoting healthy management of diabetes. Two hundred six subjects were randomized to receive either BA or ST between 2009 and 2013. Cost-effectiveness was calculated as incremental cost-effectiveness ratio (ICER) of BA versus ST. Total costs for BA and ST per participant were $259.02 and $216.12, respectively. At the 6-month follow-up, 87.91% of BA subjects received a DFE compared to 34.48% of ST subjects. The ICER for BA versus ST was $80.29/percent increase in DFE rate. In terms of improving DFE rates, BA was found to be more cost-effective than ST.
authors.affiliation: 1 Thomas Jefferson University, Philadelphia, PA.
authors.forename: David
authors.initials: D
authors.lastname: Winters
authors.affiliation: 2 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Robin
authors.initials: R
authors.lastname: Casten
authors.affiliation: 2 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Barry
authors.initials: B
authors.lastname: Rovner
authors.affiliation: 3 Wills Eye Hospital, Philadelphia, PA.
authors.forename: Ann
authors.initials: A
authors.lastname: Murchison
authors.affiliation: 2 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Leiby
authors.affiliation: 3 Wills Eye Hospital, Philadelphia, PA.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Haller
authors.affiliation: 3 Wills Eye Hospital, Philadelphia, PA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hark
authors.affiliation: 3 Wills Eye Hospital, Philadelphia, PA.
authors.forename: David M
authors.initials: DM
authors.lastname: Weiss
authors.affiliation: 1 Thomas Jefferson University, Philadelphia, PA.
authors.forename: Laura T
authors.initials: LT
authors.lastname: Pizzi
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000523:psychology*; D003941:Diagnostic Techniques, Ophthalmological / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000208:ethnology*; D019057:Quality-Adjusted Life Years
chemical_list: D006442:Glycated Hemoglobin
keywords: behavioral activation; cost-effectiveness; diabetes; screening