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We examined the cost-effectiveness of a care coordination/home telehealth (CCHT) programme for veterans with diabetes. We conducted a retrospective, pre-post study which compared data for a cohort of veterans ( n=370) before and after the introduction of the CCHT programme for two periods of 12 months. To assess the cost-effectiveness, we converted the patients' health-related quality of life data into Quality Adjusted Life Year (QALY) utility scores and used costs to construct incremental cost-effectiveness ratios (ICERs). The overall mean ICER for the programme at one-year was $60,941, a value within the commonly-cited range of cost-effectiveness of $50,000–100,000. The programme was cost-effective for one-third of the participants. Characteristics that contributed to cost-effectiveness were marital status, location and clinically relevant co-morbidities. By targeting the intervention differently in future work, it may become cost-effective for a greater proportion of patients.

The 1992 reauthorization of the OlderAmericans Act (OAA) requires the Assistant Secretary on Aging to produce a set of guidelines to aid states in the development of their Intrastate Funding Formula (IFF). The purpose of this investigation was to examine, using two states as case studies, the effects of a preliminary set of guidelines on planning and service areas (PSAs) that vary in the degree to which older adults (60+) in their catchment area live in nonmetropolitan versus metropolitan settings. Dollar amounts allocated to four categories of PSAs were compared with simulations of allocations under three alternative funding strategies. The data from these simulations illustrate that changes in IFF regulations have the potential to cause significant shifts in the distribution of OAA funds. Indeed, given the magnitude of the changes that could occur, there is likely to be considerable controversy within some states as lawmakers and state officials attempt to bnng current IFFs into conformity with new federal regulations.