The cost-effectiveness of improving diabetes care in U.S. federally qualified community health centers

Health Serv Res. 2007 Dec;42(6 Pt 1):2174-93; discussion 2294-323. doi: 10.1111/j.1475-6773.2007.00734.x.


Objective: To estimate the incremental cost-effectiveness of improving diabetes care with the Health Disparities Collaborative (HDC), a national collaborative quality improvement (QI) program conducted in community health centers (HCs).

Data sources/study setting: Data regarding the impact of the Diabetes HDC program came from a serial cross-sectional follow-up study (1998, 2000, 2002) of the program in 17 Midwestern HCs. Data inputs for the simulation model of diabetes came from the latest clinical trials and epidemiological studies.

Study design: We conducted a societal cost-effectiveness analysis, incorporating data from QI program evaluation into a Monte Carlo simulation model of diabetes.

Data collection/extraction methods: Data on diabetes care processes and risk factor levels were extracted from medical charts of randomly selected patients.

Principal findings: From 1998 to 2002, multiple processes of care (e.g., glycosylated hemoglobin testing [HbA1C] [71-->92 percent] and ACE inhibitor prescribing [33-->55 percent]) and risk factor levels (e.g., 1998 mean HbA1C 8.53 percent, mean difference 0.45 percent [95 percent confidence intervals -0.72, -0.17]) improved significantly. With these improvements, the HDC was estimated to reduce the lifetime incidence of blindness (17-->15 percent), end-stage renal disease (18-->15 percent), and coronary artery disease (28-->24 percent). The average improvement in quality-adjusted life year (QALY) was 0.35 and the incremental cost-effectiveness ratio was $33,386/QALY.

Conclusions: During the first 4 years of the HDC, multiple improvements in diabetes care were observed. If these improvements are maintained or enhanced over the lifetime of patients, the HDC program will be cost-effective for society based on traditionally accepted thresholds.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Community Health Centers / economics*
  • Community Health Centers / standards
  • Community Health Centers / statistics & numerical data
  • Cooperative Behavior
  • Cost-Benefit Analysis
  • Cross-Sectional Studies
  • Diabetes Mellitus / economics*
  • Diabetes Mellitus / prevention & control
  • Female
  • Glycated Hemoglobin A / analysis
  • Health Status Disparities
  • Humans
  • Male
  • Middle Aged
  • Midwestern United States
  • Models, Statistical
  • Monte Carlo Method
  • Process Assessment, Health Care / economics*
  • Program Development*
  • Program Evaluation*
  • Quality Indicators, Health Care
  • Quality-Adjusted Life Years*
  • Risk Factors


  • Glycated Hemoglobin A