Cost‐Effectiveness of a Culturally Adapted Diabetes Self‐Management Education Program for Marshallese Adults With Type 2 Diabetes‐a State‐Transition Markov Analysis
Authors' conclusion
The culturally adapted DSME program for Marshallese adults with T2D is a cost-effective intervention over a 20-year time horizon, although the results should be interpreted with caution because the differences in costs and health outcomes between the intervention strategies were modest.
Study context
- Population
- Marshallese adults with T2D (modelled)
- Comparison
- Culturally adapted family-model DSME vs standard DSME vs usual care
- Outcome
- Incremental cost-effectiveness ratio (cost per QALY gained)
- Follow-up
- 20-year time horizon
Methodological detailsstate-transition Markov model, 20-year time horizon, healthcare sector perspective, deterministic and probabilistic sensitivity analyses, Effectiveness defined as HbA1c reduction observed in a 12-month RCT; cost and utility parameters from published literature
- State-transition Markov model
- 20-year time horizon
- Healthcare sector perspective
- Deterministic and probabilistic sensitivity analyses
- Effectiveness defined as HbA1c reduction observed in a 12-month RCT; cost and utility parameters from published literature
Main finding
As reported in the abstract
ICER · 20 years
Adapted DSME cost-effective, incremental cost-effectiveness ratio (ICER) per QALY gained
$3083
Cost-effective even at conservative willingness-to-pay (WTP) threshold per QALY
$50 000
Further findings
Probabilistic sensitivity analyses (PSA): adapted DSME preferred strategy (all three strategies compared)
- Simulations with adapted DSME preferred at WTP $50 000 per QALY
- 87.1%
- Simulations with adapted DSME preferred at WTP $100 000 per QALY
- 93.7%
Deterministic sensitivity analysis
- Results most sensitive to costs of adapted DSME program and ongoing dialysis
Original publication
Cost‐Effectiveness of a Culturally Adapted Diabetes Self‐Management Education Program for Marshallese Adults With Type 2 Diabetes‐a State‐Transition Markov Analysis. Diabetes Obes Metab. Published 17 September 2026. doi:10.
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