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
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Publicado: Public Library of Science (PLoS) 2021
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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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