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Tables
Characteristic ATSM (n=112) Usual Care (n=114) PValue ATSM = Automated telephone self-management support; BMI = body mass index; GED = general equivalency diploma; HbA1c=hemoglobin A1c. a Health literacy based on scores on the Short Test of Functional Health Literacy in Adults (s-TOF-HLA), except for Cantonese patients (n = 39), for whom these scores were not obtained. Health literacy was defined as inadequate (0–16), marginal (17–22), or adequate (23–36). b Fisher exact test. Age, mean (SD), years 55.9 (12.7) 55.8 (11.8) .9 Women, % 58.0 55.3 .4 Ethnic group, % Asian 26.8 21.9 .5 African American 14.3 23.7 Hispanic white 46.4 48.3 Non-Hispanic white 9.8 5.3 Other/unknown 2.7 0.9 Language, % English 46.4 44.7 1.0 Spanish 42.0 43.9 Cantonese 11.6 11.4 Health literacy, %a Inadequate 43.9 54.0 .1 Marginal 7.1 14.0 Adequate 49.0 32.0 Education Some high school 51.8 55.3 .6 High school graduate/GED 14.3 19.3 Some college 33.9 25.4 Insurance, % Medi-Cal 20.5 16.7 .9 Medicare 19.6 21.9 Uninsured 50.0 54.4 Other 9.8 7.0 Annual income, % <$5,000 26.9 27.3 .4 $5,000–$10,000 31.5 30.3 $10,000–$20,000 18.0 29.3 $20,000–$30,000 14.6 7.1 >$30,000 9.0 6.0 Diabetes duration, mean (SD), years 9.1 (7.3) 10.4 (8.1) .3 Diabetic educator visit year prior, % 58.0 53.5 .4 Nutritionist visit year prior, % 34.8 37.7 .7 Diabetes treatment regimen, % Diet only 0.0 2.7 .8b Oral agents only 63.4 59.8 Insulin only 10.7 9.8 Insulin and oral agents 25.9 27.7 Poor or fair health, % 74.1 78.1 .8 HbA1c, mean (SD), % 9.3 (1.8) 9.8 (2.0) .2 Blood pressure, mean (SD), mm Hg Systolic 137.8 (21.5) 138.7 (20.7) .1 Diastolic 75.7 (12.1) 77.8 (11.2) .2 BMI, mean (SD), kg/m2 30.3 (6.7) 32.3 (13.5) .3 Cost Category Brief Description Cost per Patient, $ ATSM=Automated telephone self-management support. Start-up Nurse care management for 112 patients for 9 months, setup of ATSM system in 3 languages 394 Ongoing Nurse care management for 112 patients for 9 months, research assistant recruitment/follow-up, outgoing calls, monthly charges 388 Total Both of the above 782 - Table 3.
Annual Per-Patient Cost-Utility Ratios Associated With ATSM Relative to Usual Care
Cost-Utility Ratio, $ per QALY Gaineda Model Analysis Sensitivity Analysisb ATSM=Automated telephone self-management support; QALY=quality-adjusted life-year. Notes: Cost savings were not evaluated; QALYs were estimated from scores on the 12-Item Short Form Health Survey. a This ratio was calculated as (cost of ATSM)/(QALY for ATSM – QALY for usual care). b This analysis tested a 10% variation in the estimated QALY gain of 0.012 associated with ATSM in both directions: a 10% decrease to 0.0108 and a 10% increase to 0.0132. Model A (start-up+ongoing costs) 65,167 With 10% decrease in QALY gain: 72,407 With 10% increase in QALY gain: 59,242 Model B (ongoing costs only) 32,333 With 10% decrease in QALY gain: 35,926 With 10% increase in QALY gain: 29,402
Additional Files
The Article in Brief
Cost-Effectiveness of Automated Telephone Self-Management Support With Nurse Care Management Among Patients With Diabetes
Margaret A. Handley , and colleagues
Background Diabetes is a widespread and costly condition. This study, conducted in publicly funded clinics, looks at costs and effectiveness of an automated telephone system with nurse care to support patients with type 2 diabetes in their self-management.
What This Study Found The automated telephone system with nurse care management is associated with improvements in quality of life and longevity related to patients' overall health. Using this system, a 10% increase in the number of patients meeting the American Diabetes Association's exercise guidelines can be achieved at a modest cost.
Implications
- This study is one of the first to examine the cost-effectiveness of a diabetes self-management support program that uses health communication technology to reach and involve a vulnerable population.
- Automated telephone self-management systems may help reduce inequalities in diabetes-related health in vulnerable populations.
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