Dahal Padam Kanta, Ademi Zanfina, Rawal Lal, Mahumud Rashidul Alam, Paudel Grish, Karmacharya Biraj, Sakamoto Haruka, Sugishita Tomohiko, Vandelanotte Corneel
School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, NSW, Australia.
Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD, Australia.
Glob Health Res Policy. 2024 Dec 17;9(1):52. doi: 10.1186/s41256-024-00364-z.
Prevention of type 2 diabetes is becoming an urgent public health concern in low and middle-income countries (LMICs). However, there is currently no evidence of a cost-effective approach of health behaviour interventions from community settings in low-income countries like Nepal. Therefore, this study aimed to assess the within-trial economic evaluation of a health behaviour intervention compared with usual care for managing type 2 diabetes in a community setting in Nepal.
We randomly assigned 30 clusters comprising 481 patients with type 2 diabetes of which 15 to a health behaviour intervention (n = 238 patients) and 15 to the usual care (n = 243 patients). Patients in the intervention group received community health workers-led intensive training for diabetes self-management along with regular phone calls and ongoing support from peer supporters. Costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) as costs per QALYs gained were assessed after 6-month from a healthcare system perspective. Probabilistic sensitivity analysis was conducted using 10,000 Monte Carlo simulations to assess the impact of uncertainty of cost-effectiveness analysis under the threshold of three times gross domestic product (GDP) per capita for Nepal (i.e., US $4,140).
Over the 6-month, the intervention yielded an incremental cost of US $28.55 (95% CI = US $21.26 to US $35.84) per person and an incremental QALYs of 0.0085 (95% CI = -0.0106 to 0.0275) per person. The ICER associated with the health behaviour intervention was US $3,358.82 (95% CI = US $-2005.66 to US $3,974.54) per QALY gained, which was below the estimated threshold, indicating a cost-effective approach with a net monetary benefit of US $6.64 (95% CI = US $-22.62 to US $78.01). Furthermore, the probabilistic sensitivity analysis consisting of 10,000 Monte Carlo simulations indicates that the intervention being cost-effective at the given threshold was 89.63%.
Health behaviour interventions in community settings are a cost-effective approach to manage type 2 diabetes, offering good value for money. However, more studies focused on long-term follow-up across diverse setting of LMICs should be warranted to assess the maximum impact of such interventions.
Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819) Registered on 6 May 2021.
在低收入和中等收入国家（LMICs），2型糖尿病的预防正成为一个紧迫的公共卫生问题。然而，目前尚无证据表明在尼泊尔等低收入国家的社区环境中，健康行为干预措施具有成本效益。因此，本研究旨在评估在尼泊尔社区环境中，一项健康行为干预措施与常规护理相比，在治疗2型糖尿病方面的试验期内经济评估。
我们将30个包含481例2型糖尿病患者的群组随机分组，其中15个群组接受健康行为干预（n = 238例患者），15个群组接受常规护理（n = 243例患者）。干预组的患者接受了由社区卫生工作者主导的糖尿病自我管理强化培训，以及定期电话随访和同伴支持者的持续支持。从医疗保健系统的角度，在6个月后评估成本、质量调整生命年（QALYs）以及每获得一个QALY的增量成本效益比（ICER）。使用10,000次蒙特卡洛模拟进行概率敏感性分析，以评估在尼泊尔人均国内生产总值（GDP）三倍阈值（即4,140美元）下成本效益分析不确定性的影响。
在6个月期间，干预措施每人产生的增量成本为28.55美元（95%置信区间 = 21.26美元至35.84美元），每人的增量QALYs为0.0085（95%置信区间 = -0.0106至0.0275）。与健康行为干预相关的ICER为每获得一个QALY 3,358.82美元（95%置信区间 = -2,005.66美元至3,974.54美元），低于估计阈值，表明这是一种具有成本效益的方法，净货币效益为6.64美元（95%置信区间 = -22.62美元至78.01美元）。此外，由10,000次蒙特卡洛模拟组成的概率敏感性分析表明，在给定阈值下干预措施具有成本效益的概率为89.63%。
社区环境中的健康行为干预是管理2型糖尿病的一种具有成本效益的方法，性价比高。然而，应该开展更多针对低收入和中等收入国家不同环境下长期随访的研究，以评估此类干预措施的最大影响。
澳大利亚和新西兰临床试验注册中心（ACTRN12621000531819）于2021年5月6日注册。
