Robert Mash1, Roland Kroukamp2, Tom Gaziano3, Naomi Levitt4. 1. Division of Family Medicine and Primary Care, Stellenbosch University, Box 19063, Tygerberg, 7505, South Africa. Electronic address: rm@sun.ac.za. 2. Division of Family Medicine and Primary Care, Stellenbosch University, Box 19063, Tygerberg, 7505, South Africa. Electronic address: kroukamproland4@gmail.com. 3. Division of Social Medicine and Health Inequalities, Brigham & Women's Hospital, Harvard Medical School, USA. Electronic address: tgaziano@partners.org. 4. Division of Diabetic Medicine and Endocrinology, University of Cape Town and Chronic Diseases Initiative for Africa, South Africa. Electronic address: naomi.levitt@uct.ac.za.
Abstract
OBJECTIVE: This study aimed to evaluate the cost-effectiveness of a group diabetes education program delivered by health promoters in community health centers in the Western Cape, South Africa. METHODS: The effectiveness of the education program was derived from the outcomes of a pragmatic cluster randomized controlled trial (RCT). Incremental operational costs of the intervention, as implemented in the trial, were calculated. All these data were entered into a Markov micro-simulation model to simulate clinical outcomes and health costs that were expressed as an Incremental Cost Effectiveness Ratio (ICER). RESULTS: The only significant effect from the RCT at one year was a reduction in blood pressure (systolic blood pressure -4.65 mmHg (95%CI:-9.18 to -0.12) and diastolic blood pressure -3.30 mmHg (95%CI:-5.35 to -1.26)). The ICER for the intervention, based on the assumption that the costs would recur every year and the effect could be maintained, was 1862 $/QALY gained. CONCLUSION: A structured group education program performed by mid-level trained healthcare workers at community health centers, for the management of Type II diabetes in the Western Cape, South Africa is therefore cost-effective. PRACTICE IMPLICATIONS: This cost-effectiveness analysis supports the more widespread implementation of this intervention in primary care within South Africa.
RCT Entities:
OBJECTIVE: This study aimed to evaluate the cost-effectiveness of a group diabetes education program delivered by health promoters in community health centers in the Western Cape, South Africa. METHODS: The effectiveness of the education program was derived from the outcomes of a pragmatic cluster randomized controlled trial (RCT). Incremental operational costs of the intervention, as implemented in the trial, were calculated. All these data were entered into a Markov micro-simulation model to simulate clinical outcomes and health costs that were expressed as an Incremental Cost Effectiveness Ratio (ICER). RESULTS: The only significant effect from the RCT at one year was a reduction in blood pressure (systolic blood pressure -4.65 mmHg (95%CI:-9.18 to -0.12) and diastolic blood pressure -3.30 mmHg (95%CI:-5.35 to -1.26)). The ICER for the intervention, based on the assumption that the costs would recur every year and the effect could be maintained, was 1862 $/QALY gained. CONCLUSION: A structured group education program performed by mid-level trained healthcare workers at community health centers, for the management of Type II diabetes in the Western Cape, South Africa is therefore cost-effective. PRACTICE IMPLICATIONS: This cost-effectiveness analysis supports the more widespread implementation of this intervention in primary care within South Africa.
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