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Tytuł:
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Cost-effectiveness of a Stepwise Approach vs Standard Care for Diabetes Prevention in India.
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Autorzy:
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Islek D; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Weber MB; Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia.
Ranjit Mohan A; Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India.
Mohan V; Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India.
Staimez LR; Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia.
Harish R; Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India.
Narayan KMV; Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia.
Laxy M; Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia.; Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.; German Center for Diabetes Research, Neuherberg, Germany.
Ali MK; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.; Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, Georgia.; Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia.
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Źródło:
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JAMA network open [JAMA Netw Open] 2020 Jul 01; Vol. 3 (7), pp. e207539. Date of Electronic Publication: 2020 Jul 01.
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Typ publikacji:
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Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Original Publication: Chicago, IL : American Medical Association, [2018]-
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MeSH Terms:
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Diabetes Mellitus, Type 2*/economics
Diabetes Mellitus, Type 2*/epidemiology
Diabetes Mellitus, Type 2*/prevention & control
Diabetes Mellitus, Type 2*/psychology
Mass Screening*/methods
Mass Screening*/organization & administration
National Health Programs*/economics
National Health Programs*/statistics & numerical data
Risk Reduction Behavior*
Metformin/*therapeutic use
Adult ; Body Mass Index ; Cost-Benefit Analysis ; Female ; Humans ; Hypoglycemic Agents/therapeutic use ; India/epidemiology ; Male ; Quality-Adjusted Life Years ; Risk Assessment ; Risk Factors
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Grant Information:
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P30 DK111024 United States DK NIDDK NIH HHS
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Substance Nomenclature:
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0 (Hypoglycemic Agents)
9100L32L2N (Metformin)
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Entry Date(s):
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Date Created: 20200730 Date Completed: 20201225 Latest Revision: 20201225
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Update Code:
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20240104
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DOI:
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10.1001/jamanetworkopen.2020.7539
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PMID:
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32725244
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Importance: A stepwise approach that includes screening and lifestyle modification followed by the addition of metformin for individuals with high risk of diabetes is recommended to delay progression to diabetes; however, there is scant evidence regarding whether this approach is cost-effective.
Objective: To estimate the cost-effectiveness of a stepwise approach in the Diabetes Community Lifestyle Improvement Program.
Design, Setting, and Participants: This economic evaluation study included 578 adults with impaired glucose tolerance, impaired fasting glucose, or both. Participants were enrolled in the Diabetes Community Lifestyle Improvement Program, a randomized clinical trial with 3-year follow-up conducted at a diabetes care and research center in Chennai, India.
Interventions: The intervention group underwent a 6-month lifestyle modification curriculum plus stepwise addition of metformin; the control group received standard lifestyle advice.
Main Outcomes and Measures: Cost, health benefits, and incremental cost-effectiveness ratios (ICERs) were estimated from multipayer (including direct medical costs) and societal (including direct medical and nonmedical costs) perspectives. Costs and ICERs were reported in 2019 Indian rupees (INR) and purchasing power parity-adjusted international dollars (INT $).
Results: The mean (SD) age of the 578 participants was 44.4 (9.3) years, and 364 (63.2%) were men. Mean (SD) body mass index was 27.9 (3.7), and the mean (SD) glycated hemoglobin level was 6.0% (0.5). Implementing lifestyle modification and metformin was associated with INR 10 549 (95% CI, INR 10 134-10 964) (INT $803 [95% CI, INT $771-834]) higher direct costs; INR 5194 (95% CI, INR 3187-INR 7201) (INT $395; 95% CI, INT $65-147) higher direct nonmedical costs, an absolute diabetes risk reduction of 10.2% (95% CI, 1.9% to 18.5%), and an incremental gain of 0.099 (95% CI, 0.018 to 0.179) quality-adjusted life-years per participant. From a multipayer perspective (including screening costs), mean ICERs were INR 1912 (INT $145) per 1 percentage point diabetes risk reduction, INR 191 090 (INT $14 539) per diabetes case prevented and/or delayed, and INR 196 960 (INT $14 986) per quality-adjusted life-year gained. In the scenario of a 50% increase or decrease in screening and intervention costs, the mean ICERs varied from INR 855 (INT $65) to INR 2968 (INT $226) per 1 percentage point diabetes risk reduction, from INR 85 495 (INT $6505) to INR 296 681 (INT $22 574) per diabetes case prevented, and from INR 88 121 (INT $6705) to INR 305 798 (INT $23 267) per quality-adjusted life-year gained.
Conclusions and Relevance: The findings of this study suggest that a stepwise approach for diabetes prevention is likely to be cost-effective, even if screening costs for identifying high-risk individuals are added.
