Lum Kah Yee, Oppong Raymond, Kigozi Jesse
Institute for Health Management, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia.
Health Economics Unit, University of Birmingham, UK.
Asia Pac J Public Health. 2022 Nov;34(8):752-760. doi: 10.1177/10105395221122643. Epub 2022 Aug 29.
The primary aim of this study is to assess the evidence on the cost-effectiveness of type 2 diabetes mellitus (T2DM) interventions with a focus on diabetes education, lifestyle modifications, surgical intervention, and pharmacological therapy in low- and middle-income countries (LMICs). A systematic review was conducted to identify economic evaluations of T2DM interventions published in LMICs for the period 2009-2019. A total of 25 studies were identified, with more than half of the studies being decision analytic models. Critical appraisal of the identified studies showed they were of good quality. Overall, the reported interventions in this review were very heterogeneous, which made them difficult to compare. However, there was strong evidence suggesting that diabetes education was a very cost-effective strategy in LMICs. Further evidence on affordability and budget impact of bariatric surgery is required before adopting the intervention. Metformin-based therapy showed promising evidence on cost-effectiveness and thus should be offered to T2DM patients in LMICs. On the contrary, the cost-effectiveness of lifestyle modifications remains understudied in LMICs. The findings in this review can inform policy guidance toward the inclusion of T2DM interventions in the benefit packages for Universal Health Coverage in LMICs.
本研究的主要目的是评估中低收入国家（LMICs）中2型糖尿病（T2DM）干预措施成本效益的证据，重点关注糖尿病教育、生活方式改变、手术干预和药物治疗。进行了一项系统综述，以确定2009年至2019年期间在中低收入国家发表的T2DM干预措施的经济评估。共确定了25项研究，其中一半以上的研究是决策分析模型。对所确定研究的批判性评价表明它们质量良好。总体而言，本综述中报告的干预措施非常异质，难以进行比较。然而，有强有力的证据表明，糖尿病教育在中低收入国家是一种非常具有成本效益的策略。在采用减肥手术干预之前，需要进一步了解其可负担性和预算影响的证据。基于二甲双胍的治疗在成本效益方面显示出有前景的证据，因此应提供给中低收入国家的T2DM患者。相反，生活方式改变的成本效益在中低收入国家仍未得到充分研究。本综述中的研究结果可为中低收入国家将T2DM干预措施纳入全民健康覆盖福利包的政策指导提供参考。
