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孟加拉国糖尿病预防干预措施的经济评估:一个建模研究
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.
参与式学习和行动 (PLA) 在孟加拉国显著降低了2型糖尿病 (T2DM) 发病率. 这种具有成本效益的干预措施在T2DM预防中提供了良好的价值.
科学领域:
- 公共卫生 公共卫生
- 卫生经济学 卫生经济学
- 预防医学 预防医学
背景情况:
- 2型糖尿病 (T2DM) 在全球范围内构成了重大公共卫生挑战.
- 早期干预对于管理T2DM风险因素至关重要.
- 在DMagic试验中,研究了孟加拉农村地区的新型T2DM预防策略.
研究的目的:
- 评估两种T2DM预防干预措施的长期成本效益:通过参与式学习和行动 (PLA) 动员社区,以及mHealth手机消息传递.
- 模拟在资源有限的环境中扩大这些干预措施的经济影响.
主要方法:
- 基于DMagic集群随机对照试验,开发了一个健康经济马尔科夫模型.
- 一组50岁的葡萄糖耐受性受损 (IGT) 患者在一生中被模拟.
- 结果包括成本,质量调整后寿命年 (QALY),增量成本效益比率 (ICER) 和T2DM发生率.
主要成果:
- 在IGT人群中,PLA干预将T2DM发病率从46%降至25%,每QALY获得的ICER为167 INT$.
- 移动健康干预以低成本显示出有限的有效性,每QALY获得的ICER为189 INT$.
- 在与孟加拉国人均GDP相关的支付意愿门上,PLA表现出高达90%的成本效益概率.
结论:
- 参与式学习和行动 (PLA) 是一种非常具有成本效益的T2DM预防策略.
- 在低资源环境中,PLA在降低T2DM负担方面提供了相当大的价值.
- 像PLA这样的基于社区的干预措施对公共卫生有希望.
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