Cost-effectiveness of automated telephone self-management support with nurse care management among patients with diabetes
Open accessAbstract
PURPOSE: This study evaluated the cost-effectiveness of an automated telephone self-management support with nurse care management (ATSM) intervention for patients with type 2 diabetes, which was tested among patients receiving primary care in publicly funded (safety net) clinics, focusing on non-English speakers. METHODS: We performed cost analyses in the context of a randomized trial among primary care patients comparing the effects of ATSM (n = 112) and usual care (n = 114) on diabetes-related outcomes in 4 San Francisco safety net clinics. ATSM uses interactive phone technology to provide surveillance, patient education, and one-on-one counseling, and was implemented in 3 languages for a 9-month period. Cost utility was examined using quality-adjusted life-years (QALYs) derived from changes in scores on the 12-Item Short Form Health Survey. We also examined cost-effectiveness for costs associated with a 10% increase in the proportion of patients meeting diabetes-specific public health goals for increasing exercise, as recommended by Healthy People 2010 and the American Diabetes Association. RESULTS: The annual cost of the ATSM intervention per QALY gained, relative to usual care, was $65,167 for start-up and ongoing implementation costs combined, and $32,333 for ongoing implementation costs alone. In sensitivity analyses, costs per QALY ranged from $29,402 to $72,407. The per-patient cost to achieve a 10% increase in the proportion of intervention patients meeting American Diabetes Association exercise guidelines was estimated to be $558 when all costs were considered and $277 when only ongoing costs were considered. CONCLUSIONS: The ATSM intervention for diverse patients with diabetes had a cost utility for functional outcomes similar to that of many other accepted interventions targeted at diabetes prevention and treatment, and achieved public health physical activity objectives at modest costs. Because a considerable proportion of costs were fixed, cost-utility and cost-effectiveness estimates would likely be substantially improved in a scaled-up ATSM program.
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Full economic evaluations integrating three mHealth technologies reported QALY gained values equivalent to 47.2% and 62.5% of their respective countries' GDP per capita.
“Those that integrated three mHealth technologies reported QALY gained values of equivalent to 47.2% and 62.5% of their respective countries' GDP per capita [39,40].”
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 [40]
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- Authors
- Handley, M. A., Shumway, M., & Schillinger, D.
- Affiliations
- San Francisco General Hospital (US)
- Corresponding author
- Handley, M. A.
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2008-11-01
- Volume
- 6
- Issue
- 6
- Pages
- 512-518
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC2582479
- OpenAlex
- W2167011516
- Cited by
- 95
- References
- 40
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 5 · 2020: 2 · 2019: 2 · 2018: 7 · 2017: 3 · 2016: 11 · 2015: 8 · 2014: 12 · 2013: 6 · 2012: 6
- FWCI
- 19.95
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University Libraries (University of Maryland) (submittedVersion)
- Digital Repository at the University of Maryland (University of Maryland College Park)
- Funders
- Commonwealth Fund
- California Health Care Foundation
- National Institutes of Health (RR024131)
- Agency for Healthcare Research and Quality (R18 HS17261, R21 HS014864)
- University of California, San Francisco (UL1RR024131)
- National Center for Research Resources (UL1RR024131, K23 RR16539, K23RR016539)
- 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 › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- type 2 diabetes, nursing care management, cost-effectiveness, cost-utility analysis, quality-adjusted life years, safety-net clinics, non-English speakers, physical activity, exercise recommendations, primary care, implementation costs
- MeSH terms
- Adult, Aged, Communication Barriers, Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Nursing Care, Patient Education as Topic, Primary Health Care, Self Care, Telephone, Program Evaluation, Quality-Adjusted Life Years
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