The Cost-Effectiveness of a Mobile Diabetes Management Program To Reduce Preventable Complications in an Underserved Urban Community

The types of interventions that are most effective for helping people improve glycemic control and delay the onset of complications have been identified and thoroughly studied; however, this knowledge has not translated to widespread improvements in health outcomes for people with diabetes-particularly those living in communities with limited resources. Some of the inertia stems from the insufficiency of the healthcare infrastructure of low-income communities to support these services, but an additional dilemma has been the absence of a financial model to project whether or not the healthcare system could afford to pay for the enhancements. This study examined the economic implications of instituting a mobile diabetes management support program to deliver a bundle of proven interventions to African Americans with diabetes in South Los Angeles. Monte Carlo simulations were used to conduct a probabilistic sensitivity analysis of projections of the number and cost of preventable long-term complications that could be averted by the deployment of a multifaceted mobile diabetes management program. Comparison of the projected net costs of the mobile program to current medical care expenditures for diabetes care revealed that the proposed program would likely generate cost savings for the healthcare system. This study demonstrated that this conclusion would be valid even if the mobile program is less effective than anticipated. The program prototype presented has the potential to stimulate significant social change because it offers a feasible solution for improving healthcare in underserved communities and it shows that fiscal constraints of the healthcare system are not a valid excuse for the high rates of diabetes-related complications in minority communities.