Trial reportHuman resources for health2019
Cost-effectiveness analysis of a cluster-randomized, culturally tailored, community health worker home-visiting diabetes intervention versus standard care in American Samoa.
Trial report in Human resources for health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00850824 (Diabetes Care in American Samoa), which is not on this map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Diabetes Care in American Samoa
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review.PloS one · 2021Pooled it
- Cost analysis of implementing a community health worker-led weight reduction randomized-controlled trial among prediabetic south asian patients at primary care sites in NYC.Implementation science : IS · 2025Trial
- Return on investment of community health workers in the United States: a systematic review.Lancet regional health. Americas · 2026Article
- Costs and cost-effectiveness of a culturally adapted diabetes self-management and education program for Marshallese adults.Journal of clinical and translational science · 2026Article
- Costs and cost-effectiveness of community health worker programmes focussed on non-communicable diseases in low- and middle-income countries (2015-2024): a scoping literature review.BMJ global health · 2025Article
- Task-sharing for non-communicable disease prevention and control in low- and middle-income countries in the context of health worker shortages: A systematic review.PLOS global public health · 2025Article
- Increasing access to behavioral health care: Examples of task shifting in two U.S. government health care systems.Families, systems & health : the journal of collaborative family healthcare · 2024Article
- Community health worker perspectives: examining current responsibilities and strategies for success.Archives of public health = Archives belges de sante publique · 2024Article
- Study protocol for a pilot quasi-experimental study on oral health education for nurses and community health workers in Nigeria.Frontiers in public health · 2024Article
- Testing an insurance-based monetary incentive program for exercise: RCT design and rationale.Contemporary clinical trials · 2023Article
- Improving Self-management of Type 2 Diabetes in Latinx Patients: Protocol for a Sequential Multiple Assignment Randomized Trial Involving Community Health Workers, Registered Nurses, and Family Members.JMIR research protocols · 2023Article
- Cost Effectiveness of a Cultural Physical Activity Intervention to Reduce Blood Pressure Among Native Hawaiians with Hypertension.PharmacoEconomics - open · 2022Article
- Article
- Developing an Effective Community Oral Health Workers-"Promotoras" Model for Early Head Start.Frontiers in public health · 2019Article
- Using Community Health Workers to Address Barriers to Participation and Retention in Diabetes Prevention Program: A Concept Paper.Journal of primary care & community healthReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundType 2 diabetes mellitus (T2DM) is highly prevalent in American Samoa. Community health worker (CHW) interventions may improve T2DM care and be cost-effective. Current cost-effectiveness analyses (CEA) of CHW interventions have either overlooked important cost considerations or not been based on randomized clinical trials (RCTs). The Diabetes Care in American Samoa (DCAS) intervention which occurred in 2009-2010 was a cluster-randomized, culturally tailored, home-visiting CHW intervention and improved HbA1c levels.
objectiveTo analyze the cost-effectiveness of the DCAS intervention against standard care using a RCT in a low-resource setting.
methodsWe collected clinical, utilization, and cost data over 2 years and modeled quality-adjusted life years (QALYs) gained based on the RCT glycated hemoglobin (HbA1c) improvements. We calculated an incremental cost-effectiveness ratio (ICER) from the societal perspective over a 2-year time horizon and reported all costs in 2012 USD ($).
resultsTwo hundred sixty-eight American Samoans diagnosed with T2DM were cluster randomized into the CHW (n = 104) or standard care control (n = 164) arms. The CHW arm had a mean reduction of 0.53% in HbA1c, an increase of $594 in cost, and an increase of 0.05 QALYs. The ICER for the CHW arm compared to the control arm was $1121 per percentage point HbA1c reduced and $13 191 per QALY gained.
conclusionsCompared to a variety of willingness-to-pay thresholds from $39 000 to $154 353 per QALY gained, this ICER shows that the CHW intervention is highly cost-effective. Future studies of the cost-effectiveness of CHW T2DM interventions in similar settings should model lifetime costs and QALYs gained to better assess long-term cost-effectiveness.
trial registrationClinicalTrials.gov , ID NCT00850824. Registered 9 February 2009, https://clinicaltrials.gov/ct2/show/NCT00850824 .
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.