Diabetes & metabolic syndrome · 2025
Economic evaluation of diabetes prevention interventions in Bangladesh: A modelling study.
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Mohebbi Damon, Shaha Sanjit Kumar, Kuddus Abdul, Chowdhury Md Alimul Reza, Jennings Hannah, Ahmed Naveed, Morrison Joanna, Akter Kohenour, Nahar Tasmin, King Carina, Palmer Tom, Hunter Rachael, Kiadaliri Ali, Azad Kishwar, Fottrell Edward, Haghparast-Bidgoli Hassan
Аннотация
AIM: To model the long-term cost-effectiveness of scaling up two prevention interventions against type 2 diabetes mellitus (T2DM), i.e. community mobilisation through participatory learning and action (PLA) and mHealth mobile phone messaging, implemented in rural Bangladesh as part of the "DMagic" trial.
METHODS: A health-economic Markov model of the three-arm, cluster-randomised controlled DMagic trial was developed. A cohort of individuals aged 50 years entered the model with impaired glucose tolerance (IGT). Outcomes included the costs (provider perspective), quality-adjusted life-years gained (QALY), incremental cost-effectiveness ratios (ICERs) and incidence of T2DM in a lifetime period. Deterministic and probabilistic sensitivity analyses were performed to reflect uncertainty.
RESULTS: PLA yielded substantial reductions in diabetes incidence with only 25 % of the IGT population developing T2DM (versus 46 % in the control arm). The intervention was cost-effective against control with an ICER of 167 INT$ per QALY gained. The mHealth intervention revealed limited effectiveness at low cost, leading to an ICER of 189 INT$ per QALY gained. At willingness-to-pay ranges between 3 % and 45 % of Bangladesh GDP per capita, PLA demonstrated up to 90 % probability of being cost-effective.
CONCLUSIONS: PLA is a low-cost, effective strategy to reduce the burden of T2DM, offering good value for money.
TRIAL REGISTRATION: The DMagic trial was registered with the ISRCTN registry, number ISRCTN41083256.
METHODS: A health-economic Markov model of the three-arm, cluster-randomised controlled DMagic trial was developed. A cohort of individuals aged 50 years entered the model with impaired glucose tolerance (IGT). Outcomes included the costs (provider perspective), quality-adjusted life-years gained (QALY), incremental cost-effectiveness ratios (ICERs) and incidence of T2DM in a lifetime period. Deterministic and probabilistic sensitivity analyses were performed to reflect uncertainty.
RESULTS: PLA yielded substantial reductions in diabetes incidence with only 25 % of the IGT population developing T2DM (versus 46 % in the control arm). The intervention was cost-effective against control with an ICER of 167 INT$ per QALY gained. The mHealth intervention revealed limited effectiveness at low cost, leading to an ICER of 189 INT$ per QALY gained. At willingness-to-pay ranges between 3 % and 45 % of Bangladesh GDP per capita, PLA demonstrated up to 90 % probability of being cost-effective.
CONCLUSIONS: PLA is a low-cost, effective strategy to reduce the burden of T2DM, offering good value for money.
TRIAL REGISTRATION: The DMagic trial was registered with the ISRCTN registry, number ISRCTN41083256.