COST-EFFECTIVENESS OF A DIABETES GROUP EDUCATION PROGRAMME BY HEALTH PROMOTERS WITH A GUIDING STYLE IN UNDERSERVED COMMUNITIES IN SOUTH AFRICA

Introduction and objective The prevalence of diabetes is increasing in South Africa and creating a huge burden of disease for the public sector primary care services. Not only must services provide treatment, but also effective patient education and counselling at scale. This study aimed to evaluate the cost-effectiveness of a group diabetes education programme delivered by health promoters 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 randomized 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 simulate clinical outcomes and health costs that were expressed as an Incremental Cost Effectiveness Ratio (ICER). Results and conclusions The only significant effect from the RCT at one year was a reduction in blood pressure (systolic blood pressure -4.65mmHg (95%CI:-9·18- -0·12) and diastolic blood pressure -3.30mmHg (95%CI:-5·35 - -1·26)). The ICER for the intervention, based on the assumption that the costs would recur every year and the effect could be maintained, was 1862 $/QALY gained. A structured group education program performed by mid-level trained healthcare workers at community health centres, for the management of Type 2 diabetes in the Western Cape, South Africa is therefore cost-effective. This cost-effectiveness analysis supports the more widespread implementation of this intervention in primary care within South Africa.