Cost-effectiveness of a diabetes group education programme delivered by health promoters with a guiding style in underserved communities in Cape Town, South Africa
Thesis (MMed)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Background Resource constrained primary care environments in Africa need cost-effective models of patient education to combat the emerging epidemic of non-communicable chronic diseases. This study aimed to evaluate the cost-effectiveness of a group diabetes education programme delivered by health promoters with a guiding style,in community health centres in the Western Cape, South Africa. Method The effectiveness of the education programme was derived from the outcomes of a pragmatic cluster randomised controlled trial (RCT). Incremental operational costs of the intervention, as implemented in the trial, were calculated. All these data were entered into a Markov micro-simulation model to model outcomes and cost-effectiveness expressed as an Incremental Cost Effectiveness Ratio (ICER).Data predicting risk of death from stroke and ischaemic heart disease in this model was derived from South African surveys. Results: The only significant effect from the RCT was a reduction in blood pressure at 1-year (systolic blood pressure -4.65mmHg (-9.18- -0.12) and diastolic blood pressure -3.30mmHg (-5.35 - -1.26)). The ICER for the intervention, based on the assumption that the costs would recur every year and the effect be maintained, was 1862. Conclusion: An ICER of less than 10000 for medical intervention in South Africa is considered cost-effective. A structured group education programme performed by mid-level trained healthcare workers with a guiding style at community health clinics, for the management of Type 2 diabetes in the Western Cape, South Africa is therefore cost-effective.
AFRIKAANSE OPSOMMING: Nie beskikbaar nie.