Cost-Effectiveness of a Culturally Adapted Diabetes Self-Management Education Program for Marshallese Adults With Type 2 Diabetes-a State-Transition Markov Analysis.

AIM: To assess the health and economic consequences of a culturally adapted family-model diabetes self-management education (adapted DSME) program for Marshallese adults with type 2 diabetes (T2D) compared with standard DSME and usual care. METHODS: A state-transition Markov model was constructed to predict costs and quality-adjusted life years (QALYs) over a 20-year time horizon from a healthcare sector perspective. Health states reflected T2D-related complications. Model inputs included intervention costs, complication-related costs, health state utilities, and transition probabilities. Effectiveness of the adapted and standard DSME programs was defined as the reduction in haemoglobin A1c observed in a 12-month randomized controlled trial. Cost and health utility parameters were obtained from published literature. Cost-effectiveness was evaluated using an incremental cost-effectiveness ratio (ICER) metric. Deterministic and probabilistic sensitivity analyses (PSA) were conducted in which input parameters and willingness-to-pay (WTP) thresholds were varied to reflect model uncertainty. RESULTS: The adapted DSME program was cost-effective, with an ICER of $3083 per QALY gained, even at the conservative willingness-to-pay threshold of $50 000 per QALY. The results were most sensitive to variations in the costs of the adapted DSME program and ongoing dialysis. PSA comparing all three strategies showed the adapted DSME program was the preferred strategy in 87.1% and 93.7% of simulations at WTP thresholds of $50 000 and $100 000 per QALY, respectively. CONCLUSIONS: The culturally adapted DSME program for Marshallese adults with T2D is a cost-effective intervention over a 20-year time horizon, although the results should be interpreted with caution because the differences in costs and health outcomes between the intervention strategies were modest. Nevertheless, these findings support the potential value of culturally tailored diabetes education programs and provide evidence to inform reimbursement decisions by public and private health insurers.