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Intervention costs and cost-effectiveness for a multiple-risk-factor diabetes self-management trial for Latinas: economic analysis of ¡Viva Bien!

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Translational Behavioral Medicine

Abstract

Information on cost-effectiveness of multiple-risk-factor lifestyle interventions for Latinas with diabetes is lacking. The aim of this paper is to evaluate costs and cost-effectiveness for ¡Viva Bien!, a randomized trial targeting Latinas with type 2 diabetes. We estimated 6-month costs; calculated incremental costs per behavioral, biologic, and quality-of-life change; and performed sensitivity analyses from health plan and participant perspectives. Recruitment, intervention, and participant costs were estimated at $45,896, $432,433, and $179,697, respectively. This translates to $4,634 in intervention costs per ¡Viva Bien! participant; $7,723 in both per unit reduction in hemoglobin A1c and per unit reduction in body mass index. Although costs may be higher than interventions that address one risk factor, potential risks for longer-term health-care costs are high for this at-risk group. Given the benefits of ¡Viva Bien!, cost reductions are recommended to enhance its efficiency, adoption, and long-term maintenance without diluting its effectiveness.

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References

  1. Ritzwoller, D. P., Toobert, D., Sukhanova, A., & Glasgow, R. E. (2006). Economic analysis of the Mediterranean Lifestyle Program for postmenopausal women with diabetes. The Diabetes Educator, 32, 761–769. PMID 16971709.

    Article  PubMed  Google Scholar 

  2. der Bruggen MA, Jacobs-van, van Baal, P. H., Hoogenveen, R. T., et al. (2009). Cost-effectiveness of lifestyle modification in diabetic patients. Diabetes Care, 32, 1453–1458.

    Article  Google Scholar 

  3. Narayan, K. M. V., D'Agostino, R. B., Kirk, J. K., et al. (2008). Disparities in A1c levels between Hispanic and non-Hispanic white adults with diabetes. Diabetes Care, 31, 240–246.

    PubMed  Google Scholar 

  4. Emanuele, N., Moritz, T., Klein, R., et al. (2009). Ethnicity, race, and clinically significant macular edema in the Veterans Affairs Diabetes Trial (VADT). Diabetes Research and Clinical Practice, 86, 104–110.

    Article  PubMed  Google Scholar 

  5. McWilliams, J. M., Meara, E., Zaslavsky, A. M., & Ayanian, J. Z. (2009). Differences in control of cardiovascular disease and diabetes by race, ethnicity, and education: U.S. trends from 1999 to 2006 and effects of medicare coverage. Annals of Internal Medicine, 150, 505–515.

    PubMed  Google Scholar 

  6. Lloyd-Jones, D., Adams, R., Carnethon, M., et al. (2009). Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 119, 480–486.

    Article  PubMed  Google Scholar 

  7. Pandey, D. K., Labarthe, D. R., Goff, D. C., Jr., Chan, W., & Nichaman, M. Z. (2001). Community-wide coronary heart disease mortality in Mexican Americans equals or exceeds that in non-Hispanic Whites: the Corpus Christi Heart Project. The American Journal of Medicine, 10, 87.

    Google Scholar 

  8. Hunt, K. J., Williams, K., Resendez, R. G., et al. (2002). All-cause and cardiovascular mortality among diabetic participants in the San Antonio Heart Study: evidence against the "Hispanic Paradox". Diabetes Care, 25, 1557–1563.

    Article  PubMed  Google Scholar 

  9. Slater, J., Selzer, F., Dorbala, S., et al. (2003). Ethnic differences in the presentation, treatment strategy, and outcomes of percutaneous coronary intervention (a report from the National Heart, Lung, and Blood Institute Dynamic Registry). The American Journal of Cardiology, 92, 773–778.

    Article  PubMed  Google Scholar 

  10. Flegal, K. M., Carroll, M. D., Ogden, C. L., & Johnson, C. L. (2002). Prevalence and trends in obesity among US adults, 1999–2000. JAMA, 288, 1723–1727.

    Article  PubMed  Google Scholar 

  11. Maskarinec, G., Grandinetti, A., Matsuura, G., et al. (2009). Diabetes prevalence and body mass index differ by ethnicity: the Multiethnic Cohort. Ethnicity & Disease, 19, 49–55.

    Google Scholar 

  12. Oster, N. V., Welch, V., Schild, L., et al. (2006). Differences in self-management behaviors and use of preventive services among diabetes management enrollees by race and ethnicity. Disease Management, 9, 167–175.

    Article  PubMed  Google Scholar 

  13. Melloni, C., Berger, J. S., Wang, T. Y., et al. (2010). Representation of women in randomized clinical trials of cardiovascular disease prevention. Circulation: Cardiovascular Quality and Outcomes, 3, 135–142.

    Article  Google Scholar 

  14. Glasgow, R. E., Klesges, L. M., Dzewaltowski, D. A., Bull, S. S., & Estabrooks, P. (2004). The future of health behavior change research: what is needed to improve translation of research into health promotion practice? Annals of Behavioral Medicine, 27, 3–12. PMID 14979358.

    Article  PubMed  Google Scholar 

  15. The Diabetes Prevention Program Research Group. (2005). Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the Diabetes Prevention Program. Diabetes Care, 28, 888–894.

    Article  Google Scholar 

  16. Knowler, W. C., Fowler, S. E., Hamman, R. F., et al. (2009). 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet, 374, 1677–1686.

    Article  PubMed  Google Scholar 

  17. The Diabetes Prevention Program Research Group. (2003). Costs associated with the primary prevention of type 2 diabetes mellitus in the Diabetes Prevention Program. Diabetes Care, 26, 36–47.

    Article  Google Scholar 

  18. Toobert, D. J., Glasgow, R., Strycker, L. A., et al. (2003). Biologic and quality of life outcomes from the Mediterranean Lifestyle Program: a randomized clinical trial. Diabetes Care, 26, 2288–2293.

    Article  PubMed  Google Scholar 

  19. Toobert, D. J., Glasgow, R. E., & Radcliffe, J. L. (2000). Physiologic and quality of life outcomes from the Women's Lifestyle Heart Trial. Annals of Behavioral Medicine, 22, 1–9.

    Article  PubMed  CAS  Google Scholar 

  20. Toobert, D. J., Glasgow, R. E., Nettekoven, L., & Brown, J. E. (1997). Behavioral and psychosocial effects of intensive lifestyle management for women with coronary heart disease. Patient Education and Counseling, 35, 177–188.

    Article  Google Scholar 

  21. Toobert, D. J., Strycker, L. A., Glasgow, R. E., et al. (2010). Viva bien!: overcoming recruitment challenges in a multiple-risk-factor diabetes trial. American Journal of Health Behavior, 34, 432–441.

    PubMed  Google Scholar 

  22. Osuna, D., Barrera, M. Jr., Strycker, L.A., et al. (2009). Methods for the cultural adaptation of a diabetes lifestyle intervention for latinas: an illustrative project. Health Promotion Practice [Epub ahead of print]

  23. Ritzwoller, D. P., Sukhanova, A., Gaglio, B., & Glasgow, R. E. (2009). Costing behavioral interventions: a practical guide to enhance translation. Annals of Behavioral Medicine, 37, 218–227.

    Article  PubMed  Google Scholar 

  24. Sukhanova, A., Ritzwoller, D. P., Alexander, G., et al. (2009). Cost analyses of a web-based behavioral intervention to enhance fruit and vegetable consumption. International Journal of Behavioral Nutrition and Physical Activity, 6, 92.

    Article  PubMed  Google Scholar 

  25. United States Department of Labor. Bureau of Labor Statistics (BLS). Retrieved October 7, 2010, from http://www.bls.gov.

  26. Renaud, S., de Lorgeril, M., Delaye, J., et al. (1995). Cretan Mediterranean diet for prevention of coronary heart disease. The American Journal of Clinical Nutrition, 61, 1360S–1367S.

    PubMed  CAS  Google Scholar 

  27. Sharma, A., Jofre-Bonet, M., Panca, M., Lawrenson, J. G., & Murdoch, I. (2010). Hospital-based glaucoma clinics: what are the costs to patients? Eye (London, England), 24, 999–1005.

    Article  CAS  Google Scholar 

  28. Nguyen, H. Q., Maciejewski, M. L., Gao, S., et al. (2008). Health care use and costs associated with use of a health club membership benefit in older adults with diabetes. Diabetes Care, 31, 1562–1567.

    Article  PubMed  Google Scholar 

  29. Ball, S., & Golhofner, A. (2008). Comparison of a commercial weight loss program to a fitness center. Journal of Exercise Physiology, 11, 1–12. Retrieved February 23, 2011, from http://faculty.css.edu/tboone2/asep/BallJEPonlineJune2008.pdf.

  30. Center for Medical Technology Policy. Patient-Centered Outcomes Research Institute. Retrieved October 7, 2010, from http://www.cmtpnet.org/comparative-effectiveness/overview-of-the-patient-centered-outcomes-research-institute.

  31. Institute of Medicine, Committee on Quality Health Care in America. (2003). Crossing the quality chasm: a new health system for the 21st century. Washington: National Academies Press.

    Google Scholar 

  32. Glasgow, R. E., Strycker, L. A., Kurz, D., et al. (2010). Recruitment for an internet-based diabetes self-management program: scientific and ethical implications. Annals of Behavioral Medicine, 40, 40–48.

    Article  PubMed  Google Scholar 

  33. Finkelstein, E. A., Troped, P. J., Will, J. C., & Palombo, R. (2002). Cost-effectiveness of a cardiovascular disease risk reduction program aimed at financially vulnerable women: the Massachusetts WISEWOMAN project. Journal of Women’s Health and Gender-Based Medicine, 11, 519–526.

    Article  PubMed  Google Scholar 

  34. Bennett, G. G., & Glasgow, R. E. (2009). The delivery of public health interventions via the Internet: actualizing their potential. Annual Review of Public Health, 30, 273–292.

    Article  PubMed  Google Scholar 

  35. Mechael, P., Batavia, H., Kaonga, N., et al. (2010). Barriers and gaps affecting mHealth in low and middle income countries: policy white paper datasheet. Report/White Paper. The Earth Institute Columbia University, mHealth Alliance.

  36. Kennedy, A., Reeves, D., Bower, P., et al. (2007). The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. Journal of Epidemiology and Community Health, 61, 254–261.

    Article  PubMed  Google Scholar 

  37. Ayala, G. X., Vaz, L., Earp, J. A., Elder, J. P., & Cherrington, A. (2010). Outcome effectiveness of the lay health advisor model among Latinos in the United States: an examination by role. Health Education Research, 25, 815–840.

    Article  PubMed  Google Scholar 

  38. Sterman, J. (2006). Learning from evidence in a complex world. American Journal of Public Health, 96, 505–514.

    Article  PubMed  Google Scholar 

  39. National Cancer Institute. Cancer Intervention and Surveillance Modeling Network. Retrieved October 7, 2010, from http://cisnet.cancer.gov.

  40. Meenan, R. T., Stevens, V. J., Hornbrook, M. C., et al. (1998). Cost-effectiveness of a hospital-based smoking cessation intervention. Medical Care, 36, 670–678.

    Article  PubMed  CAS  Google Scholar 

  41. Tunis, S. R., Stryer, D. B., & Clancey, C. M. (2003). Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA, 290, 1624–1632. PMID 14506122.

    Article  PubMed  CAS  Google Scholar 

  42. Glasgow, R. E., Magid, D. J., Beck, A., Ritzwoller, D., & Estabrooks, P. A. (2005). Practical clinical trials for translating research to practice: design and measurement recommendations. Medical Care, 43, 551–557. PMID 15908849.

    Article  PubMed  Google Scholar 

  43. Medical Research Council. Leading science for better health. Retrieved February 23, 2011, from http://www.mrc.ac.uk/index.htm.

  44. Kessler, R., & Glasgow, R.E. (2010) A proposal to speed translation of healthcare intervention research into practice: dramatic change is needed. American Journal of Preventive Medicine (in press).

  45. Wing, R. R., & Hill, J. O. (2001). Successful weight loss maintenance. Annual Review of Nutrition, 21, 323–341.

    Article  PubMed  CAS  Google Scholar 

  46. Ornish, D., Brown, S. E., Scherwitz, L. W., et al. (1990). Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet, 336, 129–133.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Funding for this project was provided by the National Heart, Lung, and Blood Institute, grant #HL076151-01.

Dr. Glasgow is now Deputy Director for Dissemination and Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute. The opinions in this article do not necessarily represent those of the National Cancer Institute or any other body.

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Authors and Affiliations

  1. Institute for Health Research, Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO, 80237-8066, USA

    Debra P Ritzwoller PhD, Anna S Sukhanova MA, Russell E Glasgow PhD, Diane K King PhD & Bridget Gaglio PhD

  2. Oregon Research Institute, Eugene, OR, USA

    Lisa A Strycker MA & Deborah J Toobert PhD

Authors
  1. Debra P Ritzwoller PhD
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  2. Anna S Sukhanova MA
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  3. Russell E Glasgow PhD
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  4. Lisa A Strycker MA
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  5. Diane K King PhD
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  6. Bridget Gaglio PhD
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  7. Deborah J Toobert PhD
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Corresponding author

Correspondence to Debra P Ritzwoller PhD.

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Implications

Practice: While resource intensive interventions may be needed to produce lasting changes in complex multiple lifestyle behaviors, healthcare organizations should explore the use of a variety of technologies that could enhance efficiency and adoption these interventions.

Policy: The transparent reporting of recruitment and interventions costs are crucial requirements for the dissemination and implementation of successful behavioral interventions into non-academic settings.

Research: Future economic analyses associated with behavioral interventions should be directed towards understanding the resources needed to implement an intervention, in a variety of settings, given the expected outcome.

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Ritzwoller, D.P., Sukhanova, A.S., Glasgow, R.E. et al. Intervention costs and cost-effectiveness for a multiple-risk-factor diabetes self-management trial for Latinas: economic analysis of ¡Viva Bien!. Behav. Med. Pract. Policy Res. 1, 427–435 (2011). https://doi.org/10.1007/s13142-011-0037-z

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  • DOI: https://doi.org/10.1007/s13142-011-0037-z

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