Grujić-Vujmilović Dragana, Veljković Kristina, Gavrić Živana, Popović-Pejičić Snježana
Department of Social Medicine, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
Department of Social Medicine, Public Health Institute of the Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
Libyan J Med. 2025 Dec;20(1):2437226. doi: 10.1080/19932820.2024.2437226. Epub 2024 Dec 15.
The Republic of Srpska (RS), as a part of the Western Balkans (WB) region, has a higher diabetes prevalence than the EU. This study aims to assess the cost-effectiveness of early treatment of high-risk patients with pre-diabetes and undiagnosed diabetes in our setting. We designed a Markov chain Monte Carlo (MCMC) model which reflects the current International Diabetes Federation (IDF) three-step plan for the prevention of T2DM in those at increased risk. The model captures the evolution of the disease in FINDRISC high-risk patients from normal glucose tolerance (NGT) to impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) and then to T2DM and its complications. We developed two MCMC models, in order to follow the progression of the disease in high-risk cases, ie, when early treatment is undertaken or when it is not undertaken. The health costs and quality adjusted life years (QALY) were discounted at an annual rate of 3%. The key model parameters were varied in one-way and probabilistic sensitivity analysis. Early treatment resulted in increased life expectancy, postponement of the onset of diabetes and increased QALY for all patients. The discounted incremental cost-effectiveness-ratios (ICER) in NGT, IFG, IGT, and T2DM patients were -289.9, 9724.03, -1478.59 and 4084.67 €. In high-risk IGT patients, ICER was the most favorable, being both a cost saving and QALY gaining, with the consistent results confirmed by the sensitivity analysis. The results recommend the acceptance of a new health policy of identifying IGT patients with the use of FINDRISC questionnaire and plasma glucose measurements; providing them with a lifestyle change program; and implementing intensive diabetes treatment, as their disease progresses. Our results are especially significant for the Western Balkan countries, since this was the first cost-effectiveness study of T2DM prevention in this region.
斯普斯卡共和国（RS）作为西巴尔干地区（WB）的一部分，糖尿病患病率高于欧盟。本研究旨在评估在我们的环境中对糖尿病前期和未诊断糖尿病的高危患者进行早期治疗的成本效益。我们设计了一个马尔可夫链蒙特卡罗（MCMC）模型，该模型反映了当前国际糖尿病联盟（IDF）针对高危人群预防2型糖尿病的三步计划。该模型捕捉了芬兰糖尿病风险评分（FINDRISC）高危患者从正常糖耐量（NGT）到空腹血糖受损（IFG）或糖耐量受损（IGT），再到2型糖尿病及其并发症的疾病演变过程。我们开发了两个MCMC模型，以便跟踪高危病例中疾病的进展情况，即进行早期治疗或不进行早期治疗的情况。健康成本和质量调整生命年（QALY）以每年3%的贴现率进行贴现。在单因素和概率敏感性分析中对关键模型参数进行了变化。早期治疗使所有患者的预期寿命增加，糖尿病发病推迟，QALY增加。NGT、IFG、IGT和2型糖尿病患者的贴现增量成本效益比（ICER）分别为-289.9、9724.03、-1478.59和4084.67欧元。在高危IGT患者中，ICER最为有利，既节省成本又增加QALY，敏感性分析证实了这一一致结果。研究结果建议接受一项新的卫生政策，即使用FINDRISC问卷和血浆葡萄糖测量来识别IGT患者；为他们提供生活方式改变计划；并随着疾病进展实施强化糖尿病治疗。我们的结果对西巴尔干国家尤为重要，因为这是该地区首次进行的2型糖尿病预防成本效益研究。
