Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review
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 r...
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| creator | Bosetti, Rita Tabatabai, Laila Naufal, Georges Menser, Terri Kash, Bita |
| description | 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.
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 |
| doi_str_mv | 10.1371/journal.pone.0260139 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0260139</identifier><identifier>PMID: 34793562</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Biology and life sciences ; Care and treatment ; Complications ; Cost analysis ; Cost-Benefit Analysis - economics ; Costs ; Databases, Factual ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus - economics ; Diabetes Mellitus - epidemiology ; Disease Management ; Endocrinology ; Evaluation ; Financial Stress ; Glucose ; Grey literature ; Guidelines ; Health care ; Health Facilities ; Health risks ; Health Services Accessibility - economics ; Health Services Accessibility - trends ; Hemoglobin ; Humans ; Income ; Insurance Coverage ; Intervention ; Low income groups ; Medicaid ; Medical care, Cost of ; Medically Underserved Area ; Medicine and Health Sciences ; Patients ; Populations ; Public health ; Social Sciences ; Socioeconomic factors ; United States</subject><ispartof>PloS one, 2021-11, Vol.16 (11), p.e0260139-e0260139</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Bosetti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Bosetti et al 2021 Bosetti et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-e32a09acb1eb432abbe6a8626a8a5aa7995cb7552f67e565ae93fb9793b87f33</citedby><cites>FETCH-LOGICAL-c692t-e32a09acb1eb432abbe6a8626a8a5aa7995cb7552f67e565ae93fb9793b87f33</cites><orcidid>0000-0002-0398-2834</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601459/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601459/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34793562$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Ferket, Bart</contributor><creatorcontrib>Bosetti, Rita</creatorcontrib><creatorcontrib>Tabatabai, Laila</creatorcontrib><creatorcontrib>Naufal, Georges</creatorcontrib><creatorcontrib>Menser, Terri</creatorcontrib><creatorcontrib>Kash, Bita</creatorcontrib><title>Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
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.
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.
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.</description><subject>Biology and life sciences</subject><subject>Care and treatment</subject><subject>Complications</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis - economics</subject><subject>Costs</subject><subject>Databases, Factual</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - economics</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Disease Management</subject><subject>Endocrinology</subject><subject>Evaluation</subject><subject>Financial Stress</subject><subject>Glucose</subject><subject>Grey literature</subject><subject>Guidelines</subject><subject>Health care</subject><subject>Health Facilities</subject><subject>Health risks</subject><subject>Health Services Accessibility - economics</subject><subject>Health Services Accessibility - 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cost-effectiveness of diabetes management for the underserved in the United States: A systematic review</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-11-18</date><risdate>2021</risdate><volume>16</volume><issue>11</issue><spage>e0260139</spage><epage>e0260139</epage><pages>e0260139-e0260139</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.
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.
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.
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>34793562</pmid><doi>10.1371/journal.pone.0260139</doi><tpages>e0260139</tpages><orcidid>https://orcid.org/0000-0002-0398-2834</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Biology and life sciences Care and treatment Complications Cost analysis Cost-Benefit Analysis - economics Costs Databases, Factual Diabetes Diabetes mellitus Diabetes Mellitus - economics Diabetes Mellitus - epidemiology Disease Management Endocrinology Evaluation Financial Stress Glucose Grey literature Guidelines Health care Health Facilities Health risks Health Services Accessibility - economics Health Services Accessibility - trends Hemoglobin Humans Income Insurance Coverage Intervention Low income groups Medicaid Medical care, Cost of Medically Underserved Area Medicine and Health Sciences Patients Populations Public health Social Sciences Socioeconomic factors United States |
| title | Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review |
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