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. 2021 Jul 26;5(1):503-511.
doi: 10.1089/heq.2020.0134. eCollection 2021.

Cost-Effectiveness of Technology-Assisted Case Management in Low-Income, Rural Adults with Type 2 Diabetes

Leonard E Egede  1   2 , Clara E Dismuke  3 , Rebekah J Walker  1   2 , Joni S Williams  1   2 , Christian Eiler  2
Affiliations

Cost-Effectiveness of Technology-Assisted Case Management in Low-Income, Rural Adults with Type 2 Diabetes

Leonard E Egede et al. Health Equity. .

Abstract

Objective: The objective of this study was to examine whether delivering technology-assisted case management (TACM) with medication titration by nurses under physician supervision is cost effective compared with usual care (standard office procedures) in low-income rural adults with type 2 diabetes. Methods: One hundred and thirteen low-income, rural adults with type 2 diabetes and hemoglobin A1c (HbA1c) ≥8%, were randomized to a TACM intervention or usual care. Effectiveness was measured as differences in HbA1c between the TACM and usual care groups at 6 months. Total cost per patient included intervention or usual care cost, medical care cost, and income loss associated with lost workdays. The total cost per patient and HbA1c were used to estimate a joint distribution of incremental cost and incremental effect of TACM compared with usual care. Incremental cost-effectiveness ratios (ICERs) were estimated to summarize the cost-effectiveness of the TACM intervention relative to usual care to decrease HbA1c by 1%. Results: Costs due to intervention, primary care, other health care, emergency room visits, and workdays missed showed statistically significant differences between the groups (usual care $1,360.49 vs. TACM $5,379.60, p=0.004), with an absolute cost difference of $4,019.11. Based on the intervention cost per patient and the change in HbA1c, the median bootstrapped ICERs was estimated to be $6,299.04 (standard error=731.71) per 1% decrease in HbA1c. Conclusion: Based on these results, a 1% decrease in HbA1c can be obtained with the TACM intervention at an approximate cost of $6,300; therefore, it is a cost-effective option for treating vulnerable populations of adults with type 2 diabetes.

Keywords: case management; cost-effectiveness; diabetes; low-income; rural; technology.

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Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
Cost-effectiveness plane for TACM versus usual care, with bolded red dot indicating the ICER after 1000 bootstrap iterations. ICER, incremental cost-effectiveness ratio; TACM, technology-assisted case management.
FIG. 2.
FIG. 2.
Cost-effectiveness acceptability curve indicating the probability of cost-effectiveness given a willingness to pay level for the TACM intervention.
See this image and copyright information in PMC

References

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