Cost-effectiveness of a Stepwise Approach vs Standard Care for Diabetes Prevention in India

Abstract

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 costeffective.OBJECTIVE To estimate the cost-effectiveness of a stepwise approach in the Diabetes Community Lifestyle Improvement Program. DESIGN, SETTING, AND PARTICIPANTSThis 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. INTERVENTIONSThe intervention group underwent a 6-month lifestyle modification curriculum plus stepwise addition of metformin; the control group received standard lifestyle advice. MAIN OUTCOMES AND MEASURESCost, 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 $). RESULTSThe 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

Economic Evaluation of Health Behavior Interventions to Prevent and Manage Type 2 Diabetes Mellitus in Asia: A Systematic Review of Randomized Controlled Trials

“…However, no studies were identified through forward and backward searches. Finally, 11 articles met the selection criteria and were included in the review (see Figure 1 for the PRISMA flow diagram) [ 41 , 42 , 43 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ].…”

“…The included studies were conducted in Bangladesh [ 48 ], China [ 47 , 52 ] including Hong Kong [ 51 ], India [ 41 , 43 , 49 ], Malaysia [ 54 ], Singapore [ 42 , 50 ], and Sri Lanka [ 53 ] with T2DM patients and participants who were at high risk of developing T2DM. Participants included in the studies were aged 5 years and above, and the average sample size of the studies was 920 participants (study samples ranged between 166 and 3539 participants).…”

“…Participants included in the studies were aged 5 years and above, and the average sample size of the studies was 920 participants (study samples ranged between 166 and 3539 participants). The studies used a Markov model [ 47 , 51 , 53 , 54 ], decision tree [ 42 ], or randomized controlled trial [ 41 , 43 , 48 , 49 , 50 , 51 , 52 , 53 ] to make a cost-effectiveness projection. The period for the potential effectiveness of the interventions was simulated from six months to a lifetime, and all studies performed a cost-effectiveness analysis of the health behavior interventions.…”

“…Direct medical costs refer to the costs of medical services that have a direct impact on health status, including consultation and specialist doctor fees, medicine costs, costs of diagnostic tests or imaging, hospitalization fees, costs of medical supplies (i.e., medical equipment, storage), and costs incurred when visiting healthcare providers and experts such as dieticians or endocrinologists. Direct non-medical costs refer to intervention costs and social services costs such as counseling costs, program evaluation costs, transportation costs, and associated food and accommodation costs when seeking health services [ 40 , 41 , 42 , 43 ]. When taking a societal perspective, indirect costs also refer to the community resource value costs, productivity losses, time spent by caregivers attending to the patient at the hospital/clinic, and potential loss of income [ 40 , 41 , 42 , 43 , 44 ].…”

“…Direct non-medical costs refer to intervention costs and social services costs such as counseling costs, program evaluation costs, transportation costs, and associated food and accommodation costs when seeking health services [ 40 , 41 , 42 , 43 ]. When taking a societal perspective, indirect costs also refer to the community resource value costs, productivity losses, time spent by caregivers attending to the patient at the hospital/clinic, and potential loss of income [ 40 , 41 , 42 , 43 , 44 ]. Finally, a multi-payer perspective also takes into account the expenses to collect and pay for the services through multiple entities (such as health insurance companies or government rebates) [ 45 ].…”