Economic Evaluation of Adopting a Risk Score for Diabetes Screening in Indonesia

To date, no studies have evaluated the cost-effectiveness of adopting a risk score to detect undiagnosed diabetes in Indonesia. This study aimed to compare the cost-effectiveness of 3 approaches: (1) no screening; (2) the random capillary blood glucose (RCBG) strategy, the current initial screening method with 32.8% coverage; and (3) the Finnish Diabetes Risk Score (FINDRISC) strategy, as an initial screening tool in complement to the RCBG strategy.

A decision tree and Markov hybrid model was used to analyze a hypothetical population aged 45 years at the time of screening. Incremental cost-effectiveness ratio (ICER) value was calculated from the payer's perspective using a lifetime horizon. The diagnostic accuracy of the FINDRISC was calculated based on the National Basic Health Survey, whereas other data were derived from the literature.

Compared with no screening, both the RCBG and FINDRISC strategies were cost-effective, with FINDRISC strategy showing a slightly lower ICER of $1687 per quality-adjusted life-years (QALY) compared with $1718 per QALY for RCBG strategy. When directly compared with the RCBG strategy, the FINDRISC strategy had an ICER of $1646 per QALY. Scenario analysis indicated that screening every 3 or 5 years resulted in lower ICER values compared with the base-case analysis, whereas implementing effective interventions for prediabetes yielded the lowest ICER.

Adopting the FINDRISC strategy to enhance the coverage of diabetes screening programs is cost-effective from the payer's perspective compared with the no screening or RCBG strategy in Indonesia.