Cost-Effectiveness of Peer-Educator–Delivered Lifestyle Modification for Type 2 Diabetes Prevention in a Young Healthy Population in Sri Lanka: A Trial-Based Economic Evaluation and Economic Model

Abstract

Background This study evaluated the cost effectiveness of an intensive lifestyle modification (LSM) intervention delivered by peer educators for the prevention of type 2 diabetes mellitus in a young at-risk population in a low healthcare resource setting. Objective The aim of this study was to evaluate the short-term and long-term cost effectiveness of an intensive lifestyle modification intervention for type 2 diabetes prevention in a young urban at-risk population in Sri Lanka. Methods This was an economic evaluation using cost and outcome data from a randomized controlled trial. We randomized 3539 healthy individuals aged 5-40 years with risk factors for type 2 diabetes to either 3-monthly (P-LSM n = 1727) or 12-monthly (C-LSM n = 1812) peer-educator advice aimed at reducing weight, improving diet, reducing psychological stress and increasing physical activity. A cost-effectiveness analysis was conducted from a health system perspective with outcomes expressed as disability-adjusted life-years (DALYs). Intervention costs and outcomes were collected during a median clinical trial period of 3 years and extrapolated to a lifetime horizon using economic modelling. Uncertainty in the lifetime model was explored by structural and probabilistic sensitivity analyses. Results The costs of the more intensive peer support programme were partially offset by reduced costs of type 2 diabetes complications recorded over the trial period and completely offset by lifetime cost savings of 6000 LKR. The more intensive P-LSM also averted more DALYs, estimated at 0.456 DALYs over the lifetime of participants. Conclusions In a young at-risk Sri Lanka population, an intensive LSM programme was cost effective, averting more DALYs at an acceptable additional cost than a much less intensive LSM programme. Early intervention in young at-risk people represents good value for money from the Sri Lankan health care payer perspective.

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.…”

“…Another study provided 16 sessions of health behavioral counseling over 4 months and 8 sessions of maintenance classes over 2 months [ 43 ]. In one study, peer-educators delivered four face-to-face sessions annually on lifestyle modification for 3 years [ 53 ]. One study used six years of regular health screening (i.e., initial 2 h post-glucose test for 3 months, confirmatory diagnosis test, and annual physical examination) implemented by a health worker in a health center, and counseling on health behavior change at the 3-month follow-up with a physical examination up to one year later [ 47 ].…”

“…Nine studies used a cost-effectiveness threshold for decision making (i.e., deciding to promoting a health behavior over an alternative intervention) that reflected the maximum willingness to pay per unit of the health outcome [ 41 , 42 , 43 , 47 , 48 , 50 , 51 , 53 , 54 ]. Five of nine studies used a cost-effectiveness threshold decision rule proposed by WHO [ 41 , 42 , 43 , 48 , 53 ].…”