Telephone nurse support can be cost-effective to help improve functioning and quality of life for patients with diabetes
Although diabetes-related damage to organs such as the kidneys and eyes is well recognized, diabetes also causes functional decline, depression, pain, and lost productivity. The good news is that telephone support from nurses on how to self-manage diabetes can improve patients' functioning and help them gain quality-adjusted life years (QALYs). A group of University of California, San Francisco researchers compared the cost effectiveness of automated telephone self-management (ATSM) plus nurse care management among 112 primary care patients with diabetes in 4 safety net clinics with usual care received by 114 similar patients.
ATSM used interactive phone technology to provide surveillance, patient education, and one-on-one counseling, and was implemented in languages for a 9-month period using a randomized control trial design. The per-patient cost to achieve a 10 percent increase in the proportion of ATSM patients meeting American Diabetes Association exercise guidelines was estimated to be $558 for all costs and $277 for ongoing costs alone.
The annual cost of the ATSM intervention per QALY gained, relative to usual care, was $65,167 for start-up and ongoing implementation costs combined, and $32,333 for ongoing implementation costs alone. This is a cost-effectiveness similar to that of other accepted diabetes interventions related to medication intensification (for example, $35,300 per QALY gained for intensive glucose control) and diabetes case management ($44,941 per QALY gained). The study was supported in part by the Agency for Healthcare Research and Quality (HS14864 and HS17261).
More details are in "Cost-effectiveness of automated telephone self-management support among patients with diabetes," by Margaret A. Handley, Ph.D., M.P.H., Martha Shumway, Ph.D., and Dean Schillinger, M.D., in the November/December 2008 Annals of Family Medicine 6(6), pp. 512-518.
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