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

Abstract

Health behavior interventions implemented in Asian countries often lack economic evaluations that effectively address the problems of type 2 diabetes mellitus. This review systematically assessed the existing literature on economic evaluation of health behavior interventions to prevent and manage type 2 diabetes mellitus for people living in Asian countries. Eligible studies were identified through a search of six bibliographic databases, namely, PubMed, Scopus, Public Health Database by ProQuest, Cumulative Index to Nursing and Allied Health Literature Complete, Web of Science, and Google Scholar. Randomized controlled trials of health behavior interventions and studies published in the English language from January 2000 to May 2022 were included in the review. The search yielded 3867 records, of which 11 studies were included in the review. All included studies concluded that health behavior interventions were cost-effective. Eight of these studies undertook an evaluation from a health system perspective, two studies used both societal and health system perspectives, and one study utilized a societal and multi-payer perspective. This review identified the time horizon, direct and indirect medical costs, and discount rates as the most important considerations in determining cost effectiveness. These findings have implications in extending health behavior interventions to prevent and manage type 2 diabetes mellitus in low-resource settings, and are likely to yield the most promising outcomes for people with type 2 diabetes mellitus.

Feasibility of prevention of type 2 diabetes in low- and middle-income countries

“…Cost analyses of diabetes prevention in LMICs have been conducted from various perspectives, based on within-trial or simulation modelling studies [ 58 ], with some of the first analyses coming from the Indian Diabetes Prevention Programme (IDPP) [ 59 ]. In this trial, over the 3 years of the study, the incremental cost-effectiveness ratio (ICER) to prevent one case of diabetes was US$1052 with LSM, US$1095 with metformin, and US$1359 with the combination of both.…”

A systematic review of the economic burden of diabetes mellitus: contrasting perspectives from high and low middle-income countries

“…Diabetes prevalence increases alongside healthcare expenses, straining the economy. Literature shows that type 2 diabetes-related healthcare costs have decreased economic activity and productivity (Chatterjee et al, 2011 ; Dahal et al, 2022 ; Seuring et al, 2015 ).…”

Prevalence, awareness, treatment and control of type 2 diabetes in southeast China: A population‐based study

“…Asia is the major site of a rapidly emerging diabetes epidemic. Conservative estimates based on population growth and aging, and the rate of urbanization in Asia showed that India and China would remain the two countries with the highest rates of diabetes by 2030 8 .…”