Costs and effects of a telephonic diabetes self-management support intervention using health educators
Open accessAbstract
Background Self-management is crucial to successful glycemic control in patients with diabetes, yet it requires patients to initiate and sustain complicated behavioral changes. Support programs can improve glycemic control, but may be expensive to implement. We report here an analysis of the costs of a successful telephone-based self-management support program delivered by lay health educators utilizing a municipal health department A1c registry, and relate them to near-term effectiveness.Methods Costs of implementation were assessed by micro-costing of all resources used. Per-capita costs and cost-effectiveness ratios from the perspective of the service provider are estimated for net A1c reduction, and percentages of patients achieving A1c reductions of 0.5 and 1.0 percentage points. One-way sensitivity analyses of key cost elements, and a Monte Carlo sensitivity analysis are reported.Results The telephone intervention was provided to 443 people at a net cost of $187.61 each. Each percentage point of net A1c reduction was achieved at a cost of $464.41. Labor costs were the largest component of costs, and cost-effectiveness was most sensitive to the wages paid to the health educators.Conclusions Effective telephone-based self-management support for people in poor diabetes control can be delivered by health educators at moderate cost relative to the gains achieved. The costs of doing so are most sensitive to the prevailing wage for the health educators.
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The approximately $1,400 cost of a 1.0 percentage point (11 mmol/mol) reduction in HbA1C in T1-REDEEM falls near the lower range of costs reported in these studies, which in 2017 dollars ranged from $605 for the telephone intervention delivered by lay interviewers to $9,539 for the intensive, in-person intervention.
“The approximately $1,400 cost of a 1.0 percentage point (11 mmol/mol) reduction in HbA1C observed in T1-REDEEM falls near the lower range of costs reported in these studies which, in 2017 dollars, ranged from $605 in the telephone intervention delivered by lay interviewers25 to $9,539 in the intensive, in-person intervention.26”
From Economic costs of implementing group interventions to reduce diabetes distress in adults with type 1 diabetes mellitus in the T1-REDEEM trial (2019) · cites this paper as [26]
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Experimental — accuracy not yet measuredPer participant costs ranged from $219 for a telephone intervention delivered by lay health educators to $5,390 for an intensive intervention that included a residential retreat and 6 months of weekly, 4-hour, in-person meetings.
“Per participant costs ranged from $219, for a telephone intervention delivered by lay health educators,25 to $5,390, for an intensive intervention that included a residential retreat, and 6 months of weekly, 4-hour, in-person meetings.26”
From Economic costs of implementing group interventions to reduce diabetes distress in adults with type 1 diabetes mellitus in the T1-REDEEM trial (2019) · cites this paper as [26]
Methods §2.1 describes a telephone intervention delivered by trained health educators. But Results §3.3 reports a cost specific to that intervention of $187.61 per person, not $219. The $5,390 retreat intervention is attached to a different citation in the citing sentence and is not assessed here. (LLM, conf=0.90)
Experimental — accuracy not yet measuredData that detemir is safe in pregnancy are convincing.
“Data that detemir is safe in pregnancy are convincing.1443–1446”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1444]
The Methods (§2.1) and Results (§3.1; page numbers unavailable) describe a telephone-based diabetes self-management intervention and its A1c outcomes. Searches for “detemir safe in pregnancy” and “pregnancy insulin detemir safety” found no passage addressing detemir or its safety in pregnancy. (LLM, conf=0.78)
Experimental — accuracy not yet measured
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Shumway, M., Fisher, L., Hessler, D., Bowyer, V., Polonsky, W. H., & Masharani, U. (2019) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2019.107416 · Cited by 4 · see citing works
- Authors
- Schechter, C. B., Walker, E. A., Ortega, F. M., Chamany, S., & Silver, L. D.
- Affiliations
- Albert Einstein College of Medicine (US)
- New York City Department of Health and Mental Hygiene (US)
- Corresponding author
- Schechter, Clyde B.
- Venue
- Journal of Diabetes and its Complications
- Publisher
- Elsevier BV
- Published
- 2016-03
- Volume
- 30
- Issue
- 2
- Pages
- 300-305
- ISSN
- 0891-6632 (ISSN-L)
- 1056-8727
- PMC
- PMC4761277
- OpenAlex
- W2174952265
- Cited by
- 26
- References
- 13
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2022: 4 · 2021: 4 · 2020: 5 · 2019: 2 · 2018: 4 · 2017: 1 · 2016: 1
- FWCI
- 1.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Diabetes and its Complications (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- New York City Department of Health and Mental Hygiene
- National Institutes of Health (UL1TR001073)
- National Institute of Diabetes and Digestive and Kidney Diseases (R18DK078077, P60DK020541, P30DK020541)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- 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 Research
- Keywords
- diabetes self-management support, telephone-delivered intervention, lay health educators, cost-effectiveness, glycemic control, HbA1c reduction, micro-costing, health departments, community health workers, labor costs
- MeSH terms
- Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Humans, Patient Education as Topic, Salaries and Fringe Benefits, Self Care, Social Support, Telephone, Health Care Costs, Telemedicine, Directive Counseling, Health Educators
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