Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review

<h4>Background</h4> Diabetes mellitus affects almost 10% of U.S. adults, leading to human and financial burden. Underserved populations experience a higher risk of diabetes and related complications resulting from a combination of limited disposable income, inadequate diet, and lack of i...

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Autores principales:	Rita Bosetti, Laila Tabatabai, Georges Naufal, Terri Menser, Bita Kash
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/c1cb3f2c911a47ed869c37abd7ea824a
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spelling	oai:doaj.org-article:c1cb3f2c911a47ed869c37abd7ea824a2021-11-25T06:19:42ZComprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review1932-6203https://doaj.org/article/c1cb3f2c911a47ed869c37abd7ea824a2021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601459/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4> Diabetes mellitus affects almost 10% of U.S. adults, leading to human and financial burden. Underserved populations experience a higher risk of diabetes and related complications resulting from a combination of limited disposable income, inadequate diet, and lack of insurance coverage. Without the requisite resources, underserved populations lack the ability to access healthcare and afford prescription drugs to manage their condition. The aim of this systematic review is to synthesize the findings from cost-effectiveness studies of diabetes management in underserved populations. <h4>Methods</h4> Original, English, peer-reviewed cost-effectiveness studies of diabetes management in U.S. underserved populations were obtained from 8 databases, and PRISMA 2009 reporting guidelines were followed. Evidence was categorized as strong or weak based on a combination of GRADE and American Diabetes Association guidelines. Internal validity was assessed by the Cochrane methodology. Studies were classified by incremental cost-effectiveness ratio as very cost-effective (ICER≤US$25,000), cost-effective (US$25,000<ICER≤US$50,000), marginally cost-effective (US$50,000<ICER≤US$100,000) or cost-ineffective (ICER>US$100,000). Reporting and quality of economic evaluations was assessed using the CHEERS guidelines and Recommendations of Second Panel for Cost-Effectiveness in Health and Medicine, respectively. <h4>Findings</h4> Fourteen studies were included. All interventions were found to be cost-effective or very cost-effective. None of the studies reported all 24 points of the CHEERS guidelines. Given the considered cost categories vary significantly between studies, assessing cost-effectiveness across studies has many limitations. Program costs were consistently analyzed, and a third of the included studies (n = 5) only examined these costs, without considering other costs of diabetes care. <h4>Interpretation</h4> Cost-effectiveness studies are not based on a standardized methodology and present incomplete or limited analyses. More accurate assessment of all direct and indirect costs could widen the gap between intervention and usual care. This demonstrates the urgent need for a more standardized and comprehensive cost-effectiveness framework for future studies.Rita BosettiLaila TabatabaiGeorges NaufalTerri MenserBita KashPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Rita Bosetti Laila Tabatabai Georges Naufal Terri Menser Bita Kash Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review
description	<h4>Background</h4> Diabetes mellitus affects almost 10% of U.S. adults, leading to human and financial burden. Underserved populations experience a higher risk of diabetes and related complications resulting from a combination of limited disposable income, inadequate diet, and lack of insurance coverage. Without the requisite resources, underserved populations lack the ability to access healthcare and afford prescription drugs to manage their condition. The aim of this systematic review is to synthesize the findings from cost-effectiveness studies of diabetes management in underserved populations. <h4>Methods</h4> Original, English, peer-reviewed cost-effectiveness studies of diabetes management in U.S. underserved populations were obtained from 8 databases, and PRISMA 2009 reporting guidelines were followed. Evidence was categorized as strong or weak based on a combination of GRADE and American Diabetes Association guidelines. Internal validity was assessed by the Cochrane methodology. Studies were classified by incremental cost-effectiveness ratio as very cost-effective (ICER≤US$25,000), cost-effective (US$25,000<ICER≤US$50,000), marginally cost-effective (US$50,000<ICER≤US$100,000) or cost-ineffective (ICER>US$100,000). Reporting and quality of economic evaluations was assessed using the CHEERS guidelines and Recommendations of Second Panel for Cost-Effectiveness in Health and Medicine, respectively. <h4>Findings</h4> Fourteen studies were included. All interventions were found to be cost-effective or very cost-effective. None of the studies reported all 24 points of the CHEERS guidelines. Given the considered cost categories vary significantly between studies, assessing cost-effectiveness across studies has many limitations. Program costs were consistently analyzed, and a third of the included studies (n = 5) only examined these costs, without considering other costs of diabetes care. <h4>Interpretation</h4> Cost-effectiveness studies are not based on a standardized methodology and present incomplete or limited analyses. More accurate assessment of all direct and indirect costs could widen the gap between intervention and usual care. This demonstrates the urgent need for a more standardized and comprehensive cost-effectiveness framework for future studies.
format	article
author	Rita Bosetti Laila Tabatabai Georges Naufal Terri Menser Bita Kash
author_facet	Rita Bosetti Laila Tabatabai Georges Naufal Terri Menser Bita Kash
author_sort	Rita Bosetti
title	Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review
title_short	Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review
title_full	Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review
title_fullStr	Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review
title_full_unstemmed	Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review
title_sort	comprehensive cost-effectiveness of diabetes management for the underserved in the united states: a systematic review
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/c1cb3f2c911a47ed869c37abd7ea824a
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Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review

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