University of Texas Health Science Center School of Public Health, Austin, TX 78701, USA.
Prev Chronic Dis. 2012;9:E140. doi: 10.5888/pcd9.120074.
The objective of our study was to estimate the long-term cost-effectiveness of a lifestyle modification program led by community health workers (CHWs) for low-income Hispanic adults with type 2 diabetes.
We forecasted disease outcomes, quality-adjusted life years (QALYs) gained, and lifetime costs associated with attaining different hemoglobin A1c (A1c) levels. Outcomes were projected 20 years into the future and discounted at a 3.0% rate. Sensitivity analyses were conducted to assess the extent to which our results were dependent on assumptions related to program effectiveness, projected years, discount rates, and costs.
The incremental cost-effectiveness ratio of the intervention ranged from $10,995 to $33,319 per QALY gained when compared with usual care. The intervention was particularly cost-effective for adults with high glycemic levels (A1c > 9%). The results are robust to changes in multiple parameters.
The CHW program was cost-effective. This study adds to the evidence that culturally sensitive lifestyle modification programs to control diabetes can be a cost-effective way to improve health among Hispanics with diabetes, particularly among those with high A1c levels.
本研究的目的是评估由社区卫生工作者（CHWs）领导的生活方式改变计划对 2 型糖尿病的低收入西班牙裔成年人的长期成本效益。
我们预测了不同糖化血红蛋白（A1c）水平下的疾病结局、质量调整生命年（QALYs）的获得和终生成本。结果预测至未来 20 年，并以 3.0%的贴现率贴现。进行敏感性分析以评估我们的结果在多大程度上取决于与计划效果、预测年限、贴现率和成本相关的假设。
与常规护理相比，干预的增量成本效益比在每获得一个 QALY 时为 10995 美元至 33319 美元。对于血糖水平较高的成年人（A1c>9%），该干预措施特别具有成本效益。结果对多个参数的变化具有稳健性。
CHW 计划具有成本效益。这项研究增加了证据表明，控制糖尿病的文化敏感的生活方式改变计划可以成为改善糖尿病西班牙裔人群健康的一种具有成本效益的方法，特别是在 A1c 水平较高的人群中。
