{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:07:15Z","timestamp":1789711635442,"version":"4.0.1"},"reference-count":55,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To assess the health and economic consequences of a culturally adapted family\u2010model diabetes self\u2010management education (adapted DSME) program for Marshallese adults with type 2 diabetes (T2D) compared with standard DSME and usual care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A state\u2010transition Markov model was constructed to predict costs and quality\u2010adjusted life years (QALYs) over a 20\u2010year time horizon from a healthcare sector perspective. Health states reflected T2D\u2010related complications. Model inputs included intervention costs, complication\u2010related costs, health state utilities, and transition probabilities. Effectiveness of the adapted and standard DSME programs was defined as the reduction in haemoglobin A1c observed in a 12\u2010month randomized controlled trial. Cost and health utility parameters were obtained from published literature. Cost\u2010effectiveness was evaluated using an incremental cost\u2010effectiveness ratio (ICER) metric. Deterministic and probabilistic sensitivity analyses (PSA) were conducted in which input parameters and willingness\u2010to\u2010pay (WTP) thresholds were varied to reflect model uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The adapted DSME program was cost\u2010effective, with an ICER of $3083 per QALY gained, even at the conservative willingness\u2010to\u2010pay threshold of $50\u2009000 per QALY. The results were most sensitive to variations in the costs of the adapted DSME program and ongoing dialysis. PSA comparing all three strategies showed the adapted DSME program was the preferred strategy in 87.1% and 93.7% of simulations at WTP thresholds of $50\u2009000 and $100\u2009000 per QALY, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The culturally adapted DSME program for Marshallese adults with T2D is a cost\u2010effective intervention over a 20\u2010year time horizon, although the results should be interpreted with caution because the differences in costs and health outcomes between the intervention strategies were modest. Nevertheless, these findings support the potential value of culturally tailored diabetes education programs and provide evidence to inform reimbursement decisions by public and private health insurers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71351","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:25:01Z","timestamp":1789709101000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Effectiveness of a Culturally Adapted Diabetes Self\u2010Management Education Program for Marshallese Adults With Type 2 Diabetes\u2010a State\u2010Transition Markov Analysis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4321-4836","authenticated-orcid":false,"given":"Daniel","family":"Lamprecht\u2010Carson","sequence":"first","affiliation":[{"name":"Department of Health Services Research &amp; Administration, College of Public Health University of Nebraska Medical Center  Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongmei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Health Services Research &amp; Administration, College of Public Health University of Nebraska Medical Center  Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su\u2010Hsin","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences, Department of Surgery Washington University School of Medicine  St Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pearl A.","family":"McElfish","sequence":"additional","affiliation":[{"name":"College of Medicine University of Arkansas for Medical Sciences Northwest  Springdale Arkansas USA"},{"name":"Institute for Community Health Innovation, College of Medicine, University of Arkansas for Medical Sciences  Springdale Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Andersen","sequence":"additional","affiliation":[{"name":"College of Medicine University of Arkansas for Medical Sciences Northwest  Springdale Arkansas USA"},{"name":"Institute for Community Health Innovation, College of Medicine, University of Arkansas for Medical Sciences  Springdale Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2053-3942","authenticated-orcid":false,"given":"Tzeyu L.","family":"Michaud","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, College of Public Health University of Nebraska Medical Center  Omaha Nebraska USA"},{"name":"Center for Reducing Health Disparities, College of Public Health University of Nebraska Medical Center  Omaha Nebraska USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Centers for Disease Control and Prevention \u201cNational Diabetes Statistics Report \u201d(2026) https:\/\/gis.cdc.gov\/grasp\/diabetes\/diabetesatlas\u2010statsreport.html."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/diaclin.26.2.77"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci23\u20100085"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40615\u2010016\u20100308\u2010y"},{"issue":"1","key":"e_1_2_11_6_1","first-page":"5","article-title":"Undiagnosed Hypertension and Undiagnosed Type 2 Diabetes Among Overweight and Obese Marshallese Participants in a Diabetes Prevention Program","volume":"94","author":"McElfish P. 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