尼泊尔2型糖尿病健康行为干预的长期成本效益

Long-term cost-effectiveness of health behaviour intervention to manage type 2 diabetes in Nepal.

作者信息

Dahal Padam Kanta, Vandelanotte Corneel, Rawal Lal, Mahumud Rashidul Alam, Paudel Grish, Lloyd Melanie, Baek Yeji, Karmacharya Biraj, Sugishita Tomohiko, Ademi Zanfina

机构信息

School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, 400 Kent Street, NSW, Rockhampton, 2000, Australia.

Appleton Institute, Physical Activity Research Group, Central Queensland University, Queensland, Australia.

出版信息

BMC Med. 2025 Mar 11;23(1):153. doi: 10.1186/s12916-025-03981-8.

DOI:10.1186/s12916-025-03981-8

PMID:40069657

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11900644/

Abstract

BACKGROUND

Long-term cost-effectiveness analyses of health behaviour interventions to effectively manage type 2 diabetes mellitus (T2DM) in low-income countries are crucial for minimising economic burden and optimising resource allocation. Therefore, this study aimed to estimate the long-term cost-effectiveness of implementing a health behaviour intervention to manage T2DM in Nepal.

METHODS

A Markov model in combination with a decision tree was developed to compare the costs and outcomes of the health behaviour intervention against usual care among 481 (238-intervention and 243-control) participants from healthcare system and societal perspectives. The model integrates empirical trial data, with published data to inform parameters not collected during the trial. The model estimated costs, quality-adjusted life years (QALYs) and cost-effectiveness over 5 years, 10 years, 20 years, 30 years and a lifetime time horizons with 3% annual discounting. Sub-group, scenarios, both one-way and two-way analyses and probabilistic sensitivity analyses (PSA) were performed to assess the impact of uncertainty in the model under the threshold of 3 times gross domestic product (GDP) per capita (i.e., US $4140) for Nepal.

RESULTS

Base-case analysis with lifetime horizon showed that the health behaviour intervention compared to usual care improved QALYs by 3.88 and increased costs by US $4293 per patient, with an incremental cost-effectiveness ratio (ICER) of US $1106 per QALY gained from a healthcare system perspective. From a societal perspective, QALYs also improved by 3.88 and costs increased by US $4550, with an ICER of US $1173 per QALY gained. Furthermore, the intervention demonstrated ICERs of US $636, US $678, US $637, and US $632 per QALY gained over 5-, 10-, 20-, and 30-year time horizons, respectively, from a healthcare system perspective, and US $719, US $766, US $659, and US $716 per QALY gained from a societal perspective. In the PSA, the probability of the health behaviour intervention being cost-effective was over 57%.

CONCLUSIONS

The health behaviour intervention for managing T2DM was cost-effective over a lifetime horizon compared to usual care. To maximise its impact, this intervention should be scaled up nationwide, and future research is warranted to assess the long-term cost-effectiveness across diverse settings in low-income countries.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819).

摘要

背景

对低收入国家有效管理2型糖尿病（T2DM）的健康行为干预措施进行长期成本效益分析，对于最小化经济负担和优化资源分配至关重要。因此，本研究旨在评估在尼泊尔实施健康行为干预措施管理T2DM的长期成本效益。

方法

开发了一个结合决策树的马尔可夫模型，从医疗系统和社会角度比较481名参与者（238名干预组和243名对照组）中健康行为干预与常规护理的成本和结果。该模型整合了实证试验数据与已发表数据，以确定试验期间未收集的参数。该模型估计了5年、10年、20年、30年和终身时间范围内的成本、质量调整生命年（QALYs）和成本效益，年贴现率为3%。进行了亚组、情景、单因素和双因素分析以及概率敏感性分析（PSA），以评估模型不确定性在尼泊尔人均国内生产总值（GDP）3倍（即4140美元）阈值下的影响。

结果

终身时间范围的基础案例分析表明，与常规护理相比，健康行为干预使每位患者的QALYs提高了3.88，成本增加了4293美元，从医疗系统角度来看，每获得一个QALY的增量成本效益比（ICER）为1106美元。从社会角度来看，QALYs也提高了3.88，成本增加了4550美元，每获得一个QALY的ICER为1173美元。此外，从医疗系统角度来看，在5年、10年、20年和30年时间范围内，干预措施每获得一个QALY的ICER分别为636美元、678美元、637美元和632美元，从社会角度来看，每获得一个QALY的ICER分别为719美元、766美元、659美元和716美元。在PSA中，健康行为干预具有成本效益的概率超过57%。