Cost-effectiveness of a diabetes group education program delivered by health promoters with a guiding style in underserved communities in Cape Town, South Africa

Objective: This study aimed to evaluate the cost-effectiveness of a group diabetes education program delivered by health promoters in community health centers in the Western Cape, South Africa. Methods: The effectiveness of the education program was derived from the outcomes of a pragmatic cluster randomized controlled trial (RCT). Incremental operational costs of the intervention, as implemented in the trial, were calculated. All these data were entered into a Markov micro-simulation model to simulate clinical outcomes and health costs that were expressed as an Incremental Cost Effectiveness Ratio (ICER). Results: The only significant effect from the RCT at one year was a reduction in blood pressure (systolic blood pressure -4.65 mmHg (95%CI: -9.18 to -0.12) and diastolic blood pressure -3.30 mmHg (95%CI: -5.35 to -1.26)). The ICER for the intervention, based on the assumption that the costs would recur every year and the effect could be maintained, was 1862 $/QALY gained. Conclusion: A structured group education program performed by mid-level trained healthcare workers at community health centers, for the management of Type II diabetes in the Western Cape, South Africa is therefore cost-effective. Practice implications: This cost-effectiveness analysis supports the more widespread implementation of this intervention in primary care within South Africa. (C) 2015 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).