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Cost-Effectiveness of a Diabetes Self-Management Education and Support Intervention Led by Community Health Workers and Peer Leaders: Projections From the Racial and Ethnic Approaches to Community Health Detroit Trial

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posted on 06.05.2021, 21:52 by Wen Ye, Shihchen Kuo, Edith C. Kieffer, Gretchen Piatt, Brandy Sinco, Gloria Palmisano, Michael S. Spencer, William H. Herman
Objective: To simulate the long-term cost-effectiveness of a peer-leader (PL)-led diabetes self-management support (DSMS) program following a structured community health worker (CHW)-led diabetes self-management education (DSME) program, in reducing risks of complications in people with type 2 diabetes (T2DM).

Research Design and Methods: The trial randomized 222 Latino adults with T2DM to 1) enhanced usual care (EUC), 2) a CHW-led, 6-month DSME program and 6 months of CHW delivered monthly telephone outreach (CHW-only), or 3) a CHW-led, 6-month DSME program and 12 months of PLs-delivered weekly group sessions with telephone outreach to those unable to attend (CHW+PL). Empirical data from the trial and the validated Michigan Model for Diabetes were used to estimate cost and health outcomes over a 20-year time horizon from a healthcare sector perspective, discounting both costs and benefits at 3% annually. The primary outcome measure was the incremental cost-effectiveness ratio (ICER).

Results: Over 20 years, the CHW+PL intervention had an ICER of $28,800 and $5,900 per quality adjusted life year (QALY) gained compared to the EUC and CHW-only interventions, respectively. The CHW-only intervention had an ICER of $430,600 per QALY gained compared to the EUC intervention. In sensitivity analyses, the results comparing the CHW+PL to EUC and CHW-only interventions were robust to changes in intervention effects and costs.

Conclusions: The CHW+PL-led DSME/DSMS intervention improved health and provided good value compared to the EUC intervention. The 6-month CHW-led DSME intervention without further post-intervention CHW support was not cost-effective in Latino adults with T2DM.


The project described was supported by Grant Number P30DK092926 (Michigan Center for Diabetes Translational Research (MCDTR), Methods and Measurement Core) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Peers for Progress grant from the American Association of Family Physicians Foundation (MCDTR, grant P30-DK-092926), Grant Number R18-DK-0785501A1 from the National Institute of Diabetes and Digestive and Kidney Diseases, and Cooperative Agreement No. U50/CCU417409 from the Centers for Disease Control and Prevention.