Cost-Effectiveness Analysis of a Community Health Worker Intervention for Low-Income Hispanic Adults with Diabetes

The objective of our study was to estimate the long-term cost-effectiveness of a lifestyle modification program led by
community health workers (CHWs) for low-income Hispanic adults with type 2 diabetes. We forecasted disease outcomes, quality-adjusted life years (QALYs) gained, and lifetime costs associated with attaining different hemoglobin A1c (A1c) levels. Outcomes were projected 20 years into the future and discounted at a 3.0% rate. Sensitivity analyses were conducted to assess the extent to which our results were dependent on assumptions related to program effectiveness, projected years, discount rates, and costs. The incremental cost-effectiveness ratio of the intervention ranged from $10,995 to $33,319 per QALY gained when
compared with usual care. The intervention was particularly cost-effective for adults with high glycemic levels (A1c >
9%). The results are robust to changes in multiple parameters. The CHW program was cost-effective. This study adds to the evidence that culturally sensitive lifestyle modification programs to control diabetes can be a cost-effective way to improve health among Hispanics with diabetes, particularly among those with high A1c levels.