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Economic evaluation of diabetes prevention interventions in Bangladesh: A modelling study
Damon Mohebbi1, Sanjit Kumar Shaha2, Abdul Kuddus2
1University College London, Institute for Global Health, London, United Kingdom; German Diabetes Centre, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Dusseldorf, Institute for Health Services Research and Health Economics, Düsseldorf, Germany; University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom; Heinrich-Heine-University Düsseldorf, Institute of General Practice (ifam), Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Düsseldorf, Germany.
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.
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