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Human Resources for Health
Published in: Human Resources for Health 1/2019

Open Access 01-12-2019 | Care | Research

Cost-effectiveness analysis of a cluster-randomized, culturally tailored, community health worker home-visiting diabetes intervention versus standard care in American Samoa

Authors: Shuo J. Huang, Omar Galárraga, Kelley A. Smith, Saipale Fuimaono, Stephen T. McGarvey

Published in: Human Resources for Health | Issue 1/2019

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Abstract

Background

Type 2 diabetes mellitus (T2DM) is highly prevalent in American Samoa. Community health worker (CHW) interventions may improve T2DM care and be cost-effective. Current cost-effectiveness analyses (CEA) of CHW interventions have either overlooked important cost considerations or not been based on randomized clinical trials (RCTs). The Diabetes Care in American Samoa (DCAS) intervention which occurred in 2009–2010 was a cluster-randomized, culturally tailored, home-visiting CHW intervention and improved HbA1c levels.

Objective

To analyze the cost-effectiveness of the DCAS intervention against standard care using a RCT in a low-resource setting.

Methods

We collected clinical, utilization, and cost data over 2 years and modeled quality-adjusted life years (QALYs) gained based on the RCT glycated hemoglobin (HbA1c) improvements. We calculated an incremental cost-effectiveness ratio (ICER) from the societal perspective over a 2-year time horizon and reported all costs in 2012 USD ($).

Results

Two hundred sixty-eight American Samoans diagnosed with T2DM were cluster randomized into the CHW (n = 104) or standard care control (n = 164) arms. The CHW arm had a mean reduction of 0.53% in HbA1c, an increase of $594 in cost, and an increase of 0.05 QALYs. The ICER for the CHW arm compared to the control arm was $1121 per percentage point HbA1c reduced and $13 191 per QALY gained.

Conclusions

Compared to a variety of willingness-to-pay thresholds from $39 000 to $154 353 per QALY gained, this ICER shows that the CHW intervention is highly cost-effective. Future studies of the cost-effectiveness of CHW T2DM interventions in similar settings should model lifetime costs and QALYs gained to better assess long-term cost-effectiveness.

Trial registration

ClinicalTrials.​gov, ID NCT00850824. Registered 9 February 2009,
Appendix
Available only for authorised users
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Metadata
Title
Cost-effectiveness analysis of a cluster-randomized, culturally tailored, community health worker home-visiting diabetes intervention versus standard care in American Samoa
Authors
Shuo J. Huang
Omar Galárraga
Kelley A. Smith
Saipale Fuimaono
Stephen T. McGarvey
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Human Resources for Health / Issue 1/2019
Electronic ISSN: 1478-4491
DOI
https://doi.org/10.1186/s12960-019-0356-6

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