Cost-effectiveness of financial incentives to improve glycemic control in adults with diabetes: A pilot randomized controlled trial

Determine the cost-effectiveness of three financial incentive structures in obtaining a 1% within group drop in HbA1c among adults with diabetes. 60 African Americans with type 2 diabetes were randomized to one of three financial incentive structures and followed for 3-months. Group 1 (low frequency...

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Bibliographic Details
Published in:PloS one 2021-03, Vol.16 (3), p.e0248762
Main Authors: Egede, Leonard E, Walker, Rebekah J, Dismuke-Greer, Clara E, Pyzyk, Sarah, Dawson, Aprill Z, Williams, Joni S, Campbell, Jennifer A
Format: Article
Language:English
Subjects:
Adult
Adults
African Americans
Behavior
Biology and life sciences
Body weight loss
Cost analysis
Cost control
Cost-Benefit Analysis
Demographic aspects
Diabetes
Diabetes mellitus
Diabetes Mellitus, Type 2 - economics
Diet
Economic analysis
Economic aspects
Economic incentives
Editing
Endocrinology
Evaluation
Glucose
Glycated Hemoglobin - analysis
Glycemic Control - economics
Government programs
Health aspects
Health care
Health care facilities
Health care policy
Hemoglobin
Humans
Incentives
Internal medicine
Intervention
Male
Management
Medicaid
Medical schools
Medicare
Medicine
Medicine and health sciences
Middle Aged
Monetary incentives
Patients
People and Places
Personal health
Physical Sciences
Population
Productivity
Project management
Reviews
Skill development
Social Sciences
Treatment Outcome
Type 2 diabetes
Vaccines
Weight loss
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Summary:Determine the cost-effectiveness of three financial incentive structures in obtaining a 1% within group drop in HbA1c among adults with diabetes. 60 African Americans with type 2 diabetes were randomized to one of three financial incentive structures and followed for 3-months. Group 1 (low frequency) received a single incentive for absolute HbA1c reduction, Group 2 (moderate frequency) received a two-part incentive for home testing of glucose and absolute HbA1c reduction and Group 3 (high frequency) received a multiple component incentive for home testing, attendance of weekly telephone education classes and absolute HbA1c reduction. The primary clinical outcome was HbA1c reduction within each arm at 3-months. Cost for each arm was calculated based on the cost of the intervention, cost of health care visits during the 3-month time frame, and cost of workdays missed from illness. Incremental cost effectiveness ratios (ICER) were calculated based on achieving a 1% within group drop in HbA1c and were bootstrapped with 1,000 replications. The ICER to decrease HbA1c by 1% was $1,100 for all three arms, however, bootstrapped standard errors differed with Group 1 having twice the variation around the ICER coefficient as Groups 2 and 3. ICERs were statistically significant for Groups 2 and 3 (p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0248762