Cost-effectiveness of financial incentives to improve glycemic control in adults with diabetes: A pilot randomized controlled trial

Abstract

Purpose Determine the cost-effectiveness of three financial incentive structures in obtaining a 1% within group drop in HbA1c among adults with diabetes. Methods 60 African Americans with type 2 diabetes were randomized to one of three financial incentive structures and followed for 3-months. Group 1 (low frequency) received a single incentive for absolute HbA1c reduction, Group 2 (moderate frequency) received a two-part incentive for home testing of glucose and absolute HbA1c reduction and Group 3 (high frequency) received a multiple component incentive for home testing, attendance of weekly telephone education classes and absolute HbA1c reduction. The primary clinical outcome was HbA1c reduction within each arm at 3-months. Cost for each arm was calculated based on the cost of the intervention, cost of health care visits during the 3-month time frame, and cost of workdays missed from illness. Incremental cost effectiveness ratios (ICER) were calculated based on achieving a 1% within group drop in HbA1c and were bootstrapped with 1,000 replications. Results The ICER to decrease HbA1c by 1% was $1,100 for all three arms, however, bootstrapped standard errors differed with Group 1 having twice the variation around the ICER coefficient as Groups 2 and 3. ICERs were statistically significant for Groups 2 and 3 (p<0.001) indicating they are cost effective interventions. Conclusions Given ICERs of prior diabetes interventions range from $1,000-$4,000, a cost of $1,100 per 1% within group decrease in HbA1c is a promising intervention. Multi-component incentive structures seem to have the least variation in cost-effectiveness.

Cost-Savings Associated with Multi-Disciplinary Team Approach for Reducing Macrovascular and Microvascular Complications in Patients with Type 2 Diabetes: A Predictive Model

“… 10 Siegel et al, in their systematic review, concluded that MDT interventions for T2DM patients and proper glycemic control are highly cost-effective ($11,339/QALY) in comparison with usual care. 40 Moreover, Egede et al 42 suggested Incremental cost-effectiveness ratios (ICERs) of $1000-$4000 per 1% reduction in HbA1c among multi-component diabetes interventions.…”

“…However, there is no significant difference in the costs of in-patient hospitalizations due to cardiovascular or microvascular complications. 10 40 Moreover, Egede et al 42 suggested Incremental costeffectiveness ratios (ICERs) of $1000-$4000 per 1% reduction in HbA1c among multi-component diabetes interventions.…”

Digital Health and Community Health Worker Support for Diabetes Management: a Randomized Controlled Trial

“…All three arms received proven effective strategies for improving blood glucose management, including basic diabetes education with goal setting, which has been shown to improve HbA1c. 37 Although both financial incentives and CHW support have previously been shown to be cost-effective strategies 38 , 39 that improve diabetes outcomes 14 , 15 , 35 but have not been studied in combination. Over 80% of participants in the hybrid arm demonstrated low adherence or high blood glucose levels, even with the digital health intervention, and were thus “escalated” to receive CHW support.…”