Confirmation of Behavioral Impact and/or Health Outcome

Rates: A Prospective Evaluation

Assume a rigorous evaluation of a worksite disease management program for employees with Type 2 (T2) diabetes was conducted among 300+ E group employees and 300+ C group employees. It measured physical activity, weight control, diabetes, and absenteeism for the last 12 months, and blood glucose levels (HbA1C) at baseline. At a 12-month follow-up, the evaluation documented that the E group intervention produced “an average weight loss of 10 pounds from baseline observations, a 12% reduction in the worker absenteeism rate, and confirmed a HbA1C (glucosylated hemoglobin) T2 diabetes control rate of 80%, and a 15% reduction in the average Hb1AC values.” The C group intervention produced a “4 pound weight gain from a baseline observation, a small increase in the absenteeism rate of 4%, and an Hb1AC diabetes control rate of 65%.” If a program decides to conduct a CEA of the E versus C group intervention, it needs to confirm which of the differences were statistically significant, to document the actual costs to deliver the E group intervention method #1 and C group method #2, and compare weight loss, absenteeism, HbA1C/Type 2 diabetes rates, and control effectiveness rates. These analyses should produce a cost-effective ratio (CER), and cost per unit of effect for each impact rate.

From a cost-benefit analysis (CBA) perspective, a program could also decide to document the costs of method #1 and method #2, and the associated economic benefits for each method. Did the significant reduction in workdays lost, reduced weight, improved rates of diabetes control, produce reduced use of diabetes-related healthcare services, for example, doctor visits, medications, and/hospitalizations? Were there significant cost savings and lower expenditures for diabetes-related care and services observed for intervention #2? Did the HP-DP intervention pay for itself? In a CBA evaluation of method #1 versus method #2, a cost-to-benefit ratio (CBR) would be computed, and economic benefits, a return on investment (ROI), and dollars saved per year would be reported to employing organization management and to the workers.

Excellent discussions of successful impact and cost evaluations of adult diabetes management are presented by Rothman, DeWalt, Malone, et al., “Influence of Patient Literacy on the Effectiveness of a Primary Care-Based Diabetes Management Program,” Journal of the American Medical Association (2004) (Impact Evaluation) and by Rothman, So, Shin, et al., “Labor Characteristics and Program Costs of a Successful Diabetes Disease Management Program,” American Journal of Managed Care (2006) (Cost Evaluation).

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