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Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus
In a clinical trial, we have previously shown that a telephone intervention can significantly increase participation in dilated fundus examination (DFE) screening among low-income adults with diabetes. Here the costs and cost-effectiveness ratio of this intervention are calculated. Intervention effe...
Autores principales: | , , , |
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Formato: | Texto |
Lenguaje: | English |
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Dove Medical Press
2008
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699788/ https://www.ncbi.nlm.nih.gov/pubmed/19668428 |
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author | Schechter, Clyde B Basch, Charles E Caban, Arlene Walker, Elizabeth A |
author_facet | Schechter, Clyde B Basch, Charles E Caban, Arlene Walker, Elizabeth A |
author_sort | Schechter, Clyde B |
collection | PubMed |
description | In a clinical trial, we have previously shown that a telephone intervention can significantly increase participation in dilated fundus examination (DFE) screening among low-income adults with diabetes. Here the costs and cost-effectiveness ratio of this intervention are calculated. Intervention effectiveness was estimated as the difference in DFE utilization between the telephone intervention and print groups from the clinical trial multiplied by the size of the telephone intervention group. A micro-costing approach was used. Personnel time was aggregated from logs kept during the clinical trial of the intervention. Wage rates were taken from a commercial compensation database. Telephone charges were estimated based on prevailing fees. The cost-effectiveness ratio was calculated as the ratio of total costs of the intervention to the number of DFEs gained by the intervention. A sensitivity analysis estimated the cost-effectiveness of a more limited telephone intervention. A probabilistic sensitivity analysis using bootstrap samples from the clinical trial results quantified the uncertainties in resource utilization and intervention effectiveness. Net intervention costs were US$18,676.06, with an associated gain of 43.7 DFEs and 16.4 new diagnoses of diabetic retinopathy. The cost-effectiveness ratio is US$427.37 per DFE gained. A restricted intervention limiting the number of calls to 5, as opposed to 7, would achieve the same results, but would cost approximately 17% less. In the probabilistic sensitivity analysis, the 5th and 95th percentiles of the cost-effectiveness ratio were US$304.05 and US$692.52 per DFE gained, respectively. Our telephone intervention is more expensive than simple mail or telephone reminders used in other settings to promote preventive care; it is, however, also considerably more effective, and is effective in a low-income minority population at greater risk for diabetes complications. The costs are dominated by labor costs, and may be substantially defrayed, without loss of effectiveness, by restricting the number of telephone calls to 5 per patient. |
format | Text |
id | pubmed-2699788 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2008 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-26997882009-08-10 Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus Schechter, Clyde B Basch, Charles E Caban, Arlene Walker, Elizabeth A Clin Ophthalmol Original Research In a clinical trial, we have previously shown that a telephone intervention can significantly increase participation in dilated fundus examination (DFE) screening among low-income adults with diabetes. Here the costs and cost-effectiveness ratio of this intervention are calculated. Intervention effectiveness was estimated as the difference in DFE utilization between the telephone intervention and print groups from the clinical trial multiplied by the size of the telephone intervention group. A micro-costing approach was used. Personnel time was aggregated from logs kept during the clinical trial of the intervention. Wage rates were taken from a commercial compensation database. Telephone charges were estimated based on prevailing fees. The cost-effectiveness ratio was calculated as the ratio of total costs of the intervention to the number of DFEs gained by the intervention. A sensitivity analysis estimated the cost-effectiveness of a more limited telephone intervention. A probabilistic sensitivity analysis using bootstrap samples from the clinical trial results quantified the uncertainties in resource utilization and intervention effectiveness. Net intervention costs were US$18,676.06, with an associated gain of 43.7 DFEs and 16.4 new diagnoses of diabetic retinopathy. The cost-effectiveness ratio is US$427.37 per DFE gained. A restricted intervention limiting the number of calls to 5, as opposed to 7, would achieve the same results, but would cost approximately 17% less. In the probabilistic sensitivity analysis, the 5th and 95th percentiles of the cost-effectiveness ratio were US$304.05 and US$692.52 per DFE gained, respectively. Our telephone intervention is more expensive than simple mail or telephone reminders used in other settings to promote preventive care; it is, however, also considerably more effective, and is effective in a low-income minority population at greater risk for diabetes complications. The costs are dominated by labor costs, and may be substantially defrayed, without loss of effectiveness, by restricting the number of telephone calls to 5 per patient. Dove Medical Press 2008-12 2008-12 /pmc/articles/PMC2699788/ /pubmed/19668428 Text en © 2008 Schechter et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. |
spellingShingle | Original Research Schechter, Clyde B Basch, Charles E Caban, Arlene Walker, Elizabeth A Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus |
title | Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus |
title_full | Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus |
title_fullStr | Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus |
title_full_unstemmed | Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus |
title_short | Cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus |
title_sort | cost effectiveness of a telephone intervention to promote dilated fundus examination in adults with diabetes mellitus |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699788/ https://www.ncbi.nlm.nih.gov/pubmed/19668428 |
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