Glycated haemoglobin versus fasting plasma glucose for type 2 diabetes point of care screening: a decision model cost-effectiveness analysis.

INTRODUCTION

Whereas fasting plasma glucose (FPG) is cheaper, the glycated haemoglobin (HBA1c) test, which does not require fasting, is more convenient for diabetes screening and could be available to patients throughout the day. In this study, we compared the cost effectiveness of the HBA1c test to that of the FPG test when used for point-of-care (POC) screening of type 2 diabetes in a low-resource setting in Uganda.

METHODS

A cost-effectiveness analysis from a societal perspective was conducted for a single screening cycle of 1659 adults aged 35-70 years receiving care at the outpatient department of a general hospital. We constructed a decision analysis model using TreeAge Pro Healthcare v2023, with the cost estimated using an ingredient approach and the effectiveness measured based on the proportion of patients correctly diagnosed with diabetes.

RESULTS

The unit cost was US$ 6.48 for the HBA1c test and US$ 8.39 for the FPG test. However, a marginally greater percentage of patients were correctly diagnosed according to the FPG test (96.3%) than the HBA1c test (96.2%). The cost-effectiveness ratio was $6.74 for the HBA1c test and $8.39 for the FPG test. The incremental cost effectiveness ratio was $989.06 per additional patient correctly diagnosed with diabetes.

CONCLUSION

HBA1c POC testing could be a more cost-effective alternative to the FPG POC test for the screening of diabetes in under-served outpatient populations in Uganda and similar contexts.