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Cost-effectiveness of Implementing the Interventions for Diabetes Prevention and Control in the Community and Military Settings

Kuo, Shihchen (2013) Cost-effectiveness of Implementing the Interventions for Diabetes Prevention and Control in the Community and Military Settings. Doctoral Dissertation, University of Pittsburgh.

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    Abstract

    Diabetes is an increasingly prevalent and costly cause of morbidity and mortality, representing not only a major clinical care concern but an immense public health challenge. In 2010, diabetes affected 25.8 million Americans – 8.3% of the US population and 26.9% of those aged 65 years or older. People with diabetes are disproportionately affected by eye and renal disease, non-traumatic amputations, and cardiovascular disease, which result in significant health-care costs of $245 billion in the US in 2012. Although many interventions can reduce health burden of diabetes, health care resources are limited. Hence, evidence is needed to inform health care practitioners and policymakers of these interventions’ costs and benefits to practices, payers, and patients, and thus aid them in prioritizing the interventions for diabetes prevention and control. Through a decision-analytic approach using computational modeling, this dissertation proposed the cost-effectiveness analysis on implementing the Chronic Care Model (CCM) for diabetes control in the community and military settings and on implementing an Online adaptation of the Diabetes Prevention Program lifestyle intervention (ODPP) for weight management in an overweight/obese primary care population with high cardiovascular risk. Our analyses showed that from a health care system and a societal perspective, the CCM compared with usual care cost $42,179-$45,495 and $42,051-$113,280 per quality-adjusted life-year (QALY) gained; the CCM compared with provider continuing medical education (PROV) cost $17,186 and $50,718 per QALY gained; and the ODPP compared with usual care cost $7,777-$14,351 and $18,263-$29,331 per QALY gained. Generally, these results were robust in sensitivity analyses. This dissertation provided supporting evidence that compared with usual care or PROV, the CCM for secondary and tertiary diabetes prevention in the community and military settings as well as the ODPP for primary diabetes prevention in the primary care setting appear to be economically reasonable interventions for diabetes management. These findings are of public health significance as the economic evaluation conducted in this dissertation is an important component of evidence-based clinical and public health practices, which is a decision making aid to help assess the relative value of alternative interventions that can enhance clinical care and public health.


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    Item Type: University of Pittsburgh ETD
    ETD Committee:
    ETD Committee TypeCommittee MemberEmail
    Committee ChairZgibor, Janice C.edcjan@pitt.edu
    Committee MemberSonger, Thomas J.tjs@pitt.edu
    Committee MemberBryce, Cindy L.bryce99@pitt.edu
    Committee MemberSmith, Kenneth J.smithkj2@upmc.edu
    Committee MemberRuppert, Kristine M.ruppertk@pitt.edu
    Title: Cost-effectiveness of Implementing the Interventions for Diabetes Prevention and Control in the Community and Military Settings
    Status: Published
    Abstract: Diabetes is an increasingly prevalent and costly cause of morbidity and mortality, representing not only a major clinical care concern but an immense public health challenge. In 2010, diabetes affected 25.8 million Americans – 8.3% of the US population and 26.9% of those aged 65 years or older. People with diabetes are disproportionately affected by eye and renal disease, non-traumatic amputations, and cardiovascular disease, which result in significant health-care costs of $245 billion in the US in 2012. Although many interventions can reduce health burden of diabetes, health care resources are limited. Hence, evidence is needed to inform health care practitioners and policymakers of these interventions’ costs and benefits to practices, payers, and patients, and thus aid them in prioritizing the interventions for diabetes prevention and control. Through a decision-analytic approach using computational modeling, this dissertation proposed the cost-effectiveness analysis on implementing the Chronic Care Model (CCM) for diabetes control in the community and military settings and on implementing an Online adaptation of the Diabetes Prevention Program lifestyle intervention (ODPP) for weight management in an overweight/obese primary care population with high cardiovascular risk. Our analyses showed that from a health care system and a societal perspective, the CCM compared with usual care cost $42,179-$45,495 and $42,051-$113,280 per quality-adjusted life-year (QALY) gained; the CCM compared with provider continuing medical education (PROV) cost $17,186 and $50,718 per QALY gained; and the ODPP compared with usual care cost $7,777-$14,351 and $18,263-$29,331 per QALY gained. Generally, these results were robust in sensitivity analyses. This dissertation provided supporting evidence that compared with usual care or PROV, the CCM for secondary and tertiary diabetes prevention in the community and military settings as well as the ODPP for primary diabetes prevention in the primary care setting appear to be economically reasonable interventions for diabetes management. These findings are of public health significance as the economic evaluation conducted in this dissertation is an important component of evidence-based clinical and public health practices, which is a decision making aid to help assess the relative value of alternative interventions that can enhance clinical care and public health.
    Date: 27 September 2013
    Date Type: Publication
    Defense Date: 22 May 2013
    Approval Date: 27 September 2013
    Submission Date: 17 July 2013
    Release Date: 27 September 2013
    Access Restriction: No restriction; The work is available for access worldwide immediately.
    Patent pending: No
    Number of Pages: 286
    Institution: University of Pittsburgh
    Thesis Type: Doctoral Dissertation
    Refereed: Yes
    Degree: PhD - Doctor of Philosophy
    Uncontrolled Keywords: Cost-effectiveness, Decision-analytic modeling, Diabetes management
    Schools and Programs: Graduate School of Public Health > Epidemiology
    Date Deposited: 27 Sep 2013 10:34
    Last Modified: 28 Sep 2013 01:15

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