Amirsadri Mohammadreza, Torkpour Elahe
Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, I.R. Iran.
Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran.
Res Pharm Sci. 2023 Jan 19;18(2):210-218. doi: 10.4103/1735-5362.367799. eCollection 2023 Apr.
Several studies have shown the effectiveness of screening programs in decreasing the costs and disutility of type-2 diabetes and related complications. As there is a growth in the incidence of type-2 diabetes amongst the Iranian population, the cost-effectiveness of performing type-2 diabetes screening tests in community pharmacies of Iran was evaluated in this study from the payer's perspective. The target population consisted of two hypothetical cohorts of 1000 people 40 years of age without a prior diagnosis of diabetes, for the intervention (screening test) and no-screening groups.
A Markov model was developed to evaluate the cost-effectiveness and cost-utility of a type-2 diabetes screening test in community pharmacies in Iran. A 30-year time horizon was considered in the model. Three screening programs with 5-year intervals were considered for the intervention group. The evaluated outcomes were quality-adjusted life-years (QALYs) for cost-utility-analysis and life-years-gained (LYG) for cost-effectiveness-analysis. To examine the robustness of the results, one-way and probabilistic-sensitivity analyses were applied to the model.
FINDINGS/RESULTS: The screening test represented both more effects and higher costs. The incremental effects in the base-case scenario (no-discounting) were estimated to be 0.017 and 0.0004 (approximately 0) for QALYs and LYG, respectively. The incremental cost was estimated to be 2.87 USD/patient. The estimated incremental-cost-effectiveness ratio was 164.77 USD/QALY.
This study indicated that screening for type-2 diabetes in community pharmacies of Iran could be considered highly cost-effective, as it meets the WHO criteria of the annual GDP per capita ($2757 in 2020).
多项研究表明，筛查项目在降低2型糖尿病及相关并发症的成本和失用性方面具有有效性。由于伊朗人群中2型糖尿病的发病率呈上升趋势，本研究从支付方的角度评估了在伊朗社区药房开展2型糖尿病筛查试验的成本效益。目标人群由两个假设队列组成，每组1000名40岁且既往未诊断为糖尿病的人群，分别为干预组（筛查试验）和非筛查组。
建立了一个马尔可夫模型，以评估在伊朗社区药房进行2型糖尿病筛查试验的成本效益和成本效用。模型考虑了30年的时间范围。干预组考虑了三个间隔为5年的筛查项目。评估的结果指标为成本效用分析中的质量调整生命年（QALY）和成本效益分析中的生命年增益（LYG）。为检验结果的稳健性，对模型进行了单因素和概率敏感性分析。
筛查试验显示出更多的效果和更高的成本。在基本情况（不贴现）下，QALY和LYG的增量效果分别估计为0.017和0.0004（约为0）。增量成本估计为2.87美元/患者。估计的增量成本效益比为164.77美元/QALY。
本研究表明，在伊朗社区药房进行2型糖尿病筛查可被认为具有很高的成本效益，因为它符合世界卫生组织人均国内生产总值标准（2020年为2757美元）。
