Canadian Journal of Diabetes | 2021
Economic analysis of a diabetes health coaching intervention for adults living with type 2 diabetes. A single centre evaluation from a community-based randomized controlled trial.
Abstract
Background A recent randomized controlled trial demonstrated that a community-based, telephone-delivered diabetes health coaching intervention was an effective intervention for improving diabetes management. The purpose of the current study was to determine whether this effective intervention is also cost-effective. Methods An economic evaluation, in the form of a cost-utility analysis (CUA), was used to assess the cost-effectiveness of the coaching intervention from a public payer perspective. All direct medical costs, as well as intervention implementation, were included. The outcome of the CUA was the quality adjusted life year (QALY). Uncertainty of cost-effectiveness results were estimated using non-parametric bootstraps of patient-level costs and QALYs in the coaching and control arms. A cost-effectiveness acceptability curve was used to express this uncertainty as the probability that diabetes health coaching is cost-effective across a range of values of willingness to pay (WTP) thresholds for a QALY. Findings The results show that subjects in the coaching arm incurred higher overall costs (Canadian dollars) compared to the control arm ($1,581 vs. $1,086, respectively) and incurred 0.02 more QALYs. The incremental cost-effectiveness ratio of the diabetes health coaching intervention compared to usual care was found to be $35,129/QALY, with probabilities of 67% and 82% that diabetes health coaching would be cost-effective at a willingness to pay threshold of $50,000 per QALY and $100,000 per QALY, respectively. Interpretation A community-based, telephone-delivered diabetes health coaching intervention is cost-effective. Funding We acknowledge the Canadian Institutes for Health Research for funding the trial.