A Return-on-Investment Analysis of a Community-Based Diabetes Self-Management Program In New York City

OBJECTIVETo evaluate the return on investment (ROI) of a community-based Diabetes Self-Management Program (DSMP) enhanced with health-related social needs (HRSN) screening and referrals, implemented by the New York City (NYC) Department of Health and Mental Hygiene with three community-based organizations in highly-impacted, under-resourced neighborhoods. RESEARCH DESIGN AND METHODSA retrospective cost-benefit analysis from a public-sector payer perspective was conducted among 171 adults with type 2 diabetes who completed a six-week, peer-led DSMP delivered by community health workers (CHWs) in English, Spanish, and Korean during 2018-2019. A time-driven, activity-based costing model captured direct implementation costs, CHW workforce turnover, and administrative overhead. Monetized benefits included avoided diabetes-related complications, reductions in self-reported emergency department (ED) visits and hospitalizations, and quality-adjusted life year (QALY) gains from improved medication adherence. Univariate sensitivity analyses tested robustness under conservative assumptions. RESULTSTotal program costs were $179,224; monetized benefits totaled $1,824,213, yielding a net benefit of $1,644,989 and an ROI of 918%--approximately $10 returned per $1 invested. Excluding QALY gains, ROI remained 551%. Self-reported ED visits declined from 149 to 82 and hospitalizations from 93 to 24 in the six months following intervention. Over 80% of participants reported housing instability; 72% were Medicaid-covered and 16% uninsured. Sensitivity analyses confirmed a positive ROI under all conservative scenarios. CONCLUSIONSA CHW-led, community-based DSMP integrated with HRSN screening and referrals delivered substantial economic and public health value among adults facing housing instability and structural barriers to care. Findings support inclusion of DSMP as a covered benefit in Medicaid managed care, value-based payment arrangements, and housing access initiatives to advance equitable diabetes outcomes.