To evaluate the cost‐effectiveness of Project Dulce, a culturally specific diabetes case management and self‐management training program, in four cohorts defined by insurance status.
Clinical and cost data on 3,893 persons with diabetes participating in Project Dulce were used as inputs into a diabetes simulation model.
The Center for Outcomes Research Diabetes Model, a published, peer‐reviewed and validated simulation model of diabetes, was used to evaluate life expectancy, quality‐adjusted life expectancy (QALY), cumulative incidence of complications and direct medical costs over patient lifetimes (40‐year time horizon) from a third‐party payer perspective. Cohort characteristics, treatment effects, and case management costs were derived using a difference in difference design comparing data from the Project Dulce program to a cohort of historical controls. Long‐term costs were derived from published U.S. sources. Costs and clinical benefits were discounted at 3.0 percent per annum. Sensitivity analyses were performed.
Incremental cost‐effectiveness ratios of $10,141, $24,584, $44,941, and $69,587 per QALY gained were estimated for Project Dulce participants versus control in the uninsured, County Medical Services, Medi‐Cal, and commercial insurance cohorts, respectively.
The Project Dulce diabetes case management program was associated with cost‐effective improvements in quality‐adjusted life expectancy and decreased incidence of diabetes‐related complications over patient lifetimes. Diabetes case management may be particularly cost effective for low‐income populations.
Data Sources/Study Setting