Costs and cost-effectiveness of a culturally adapted diabetes self-management and education program for Marshallese adults

Background: Culturally adapted diabetes self-management education (DSME) programs are effective in improving glycemic control and diabetes outcomes among minority populations, but data on program costs and cost-effectiveness are limited. This study aimed to assess the cost and cost-effectiveness of a culturally adapted DSME (adapted DSME) compared to a standard DSME model among Marshallese adults with type 2 diabetes (T2D). Methods: Retrospective cost and cost-effectiveness analyses (CEA) were conducted using data from the community-based trial, conducted between May 2015 and May 2018. We applied an activity-based costing approach to quantify the implementation resources. The CEA was performed using an incremental implementation cost-effectiveness ratio (ICER) measure, expressed as costs for additional unit change in hemoglobin A1c (HbA1c) over 12 months between adapted DSME and standard DSME. We further estimated the replication costs for the adapted DSME for implementation in other settings. The analysis was conducted from a community implementation perspective with a one-year time horizon. Results: Total program costs were $1,227 per participant for the adapted DSME and $122 per participant for the standard DSME. The ICER was $1434 per additional unit reduction in HbA1c. Replication costs for the adapted DSME were estimated at $125,473 (range: $62,737-$188,210). Conclusions: The culturally adapted DSME has been shown to be effective in managing T2D and may serve as a cost-effective lifestyle intervention for Marshallese individuals beyond the trial period. Future research should assess its broader economic and health impacts.