A cost-effectiveness analysis of a telephone-linked care intervention for individuals with Type 2 diabetes
Open accessAbstract
Aim To assess the cost-effectiveness of an automated telephone-linked care intervention, Australian TLC Diabetes, delivered over 6 months to patients with established Type 2 diabetes mellitus and high glycated haemoglobin level, compared to usual care.Methods A Markov model was designed to synthesize data from a randomized controlled trial of TLC Diabetes (n=120) and other published evidence. The 5-year model consisted of three health states related to glycaemic control: 'sub-optimal' HbA1c ≥58mmol/mol (7.5%); 'average' ≥48-57mmol/mol (6.5-7.4%) and 'optimal' <48mmol/mol (6.5%) and a fourth state 'all-cause death'. Key outcomes of the model include discounted health system costs and quality-adjusted life years (QALYS) using SF-6D utility weights. Univariate and probabilistic sensitivity analyses were undertaken.Results Annual medication costs for the intervention group were lower than usual care [Intervention £1076 (95%CI: £947, £1206) versus usual care £1271 (95%CI: £1115, £1428) p=0.052]. The estimated mean cost for intervention group participants over five years, including the intervention cost, was £17,152 versus £17,835 for the usual care group. The corresponding mean QALYs were 3.381 (SD 0.40) for the intervention group and 3.377 (SD 0.41) for the usual care group. Results were sensitive to the model duration, utility values and medication costs.Conclusion The Australian TLC Diabetes intervention was a low-cost investment for individuals with established diabetes and may result in medication cost-savings to the health system. Although QALYs were similar between groups, other benefits arising from the intervention should also be considered when determining the overall value of this strategy.
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Previous studies have demonstrated the effectiveness and cost-effectiveness of technology-enabled programs, including computer-based or telephone-based coaching, in promoting behavior change and self-management among adults with type 2 diabetes.
“Our previous studies and others have demonstrated the effectiveness and cost-effectiveness of using technology-enabled programs, including computer-based or telephone-based coaching, in promoting behavior change and self-management among adults with T2DM [7-9].”
One full economic evaluation integrating two mHealth technologies reported costs per QALY gained equivalent to 7% of GDP per capita in 2018, showing high cost-effectiveness based on WHO thresholds.
“Whilst the one study that integrated two mHealth technologies reported costs per QALY gained equivalent to 7% of the GDP per capita (2018) showing high cost effectiveness based on the WHO thresholds [38].”
From Cost and cost-effectiveness of mHealth interventions for the prevention and control of type 2 diabetes mellitus: A systematic review (2020) · cites this paper as [38]
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- Authors
- Gordon, L. G., Bird, D., Oldenburg, B., Friedman, R. H., Russell, A. W., & Scuffham, P. A.
- Affiliations
- Griffith University (AU)
- Queensland University of Technology (AU)
- Monash University (AU)
- Boston University (US)
- The University of Queensland (AU)
- Venue
- Diabetes Research and Clinical Practice
- Publisher
- Elsevier BV
- Published
- 2014-04
- Volume
- 104
- Issue
- 1
- Pages
- 103-111
- ISSN
- 0168-8227 (ISSN-L)
- OpenAlex
- W2089637970
- Cited by
- 23
- References
- 27
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 3 · 2020: 5 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 2 · 2015: 1 · 2014: 1 · 2013: 1
- FWCI
- 4.13
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Diabetes Research and Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Griffith Research Online (submittedVersion)
- Faculty of Health; Institute of Health and Biomedical Innovation
- Funders
- National Health Medical Research Council (NHMRC) Early Career Fellowship (496714)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, cost-effectiveness, glycemic control, HbA1c, drug costs, quality-adjusted life years, Markov model
- MeSH terms
- Adolescent, Adult, Aged, Blood Glucose, Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Male, Middle Aged, Telephone, Health Care Costs, Telemedicine, Young Adult
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