Kasujja Francis Xavier, Daivadanam Meena, Mayega Roy William, Nuwaha Fred, Kusolo Ronald, Ekirapa Elizabeth
Department of Epidemiology and Biostatistics, Makerere University, P. O. Box 7072, New Mulago Hill Road, Mulago, Kampala, Uganda.
Chronic Diseases and Cancer Theme, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda.
BMC Health Serv Res. 2025 May 9;25(1):664. doi: 10.1186/s12913-025-12840-4.
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.
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.
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.
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.
空腹血糖（FPG）检测成本较低，而糖化血红蛋白（HBA1c）检测无需空腹，对于糖尿病筛查更为便捷，患者可在一天中的任何时间进行检测。在本研究中，我们比较了在乌干达资源匮乏地区，使用糖化血红蛋白（HBA1c）检测和空腹血糖（FPG）检测进行2型糖尿病即时检测（POC）筛查的成本效益。
从社会角度对一家综合医院门诊部接受治疗的1659名35至70岁成年人进行了单轮筛查的成本效益分析。我们使用TreeAge Pro Healthcare v2023构建了一个决策分析模型，采用成分法估算成本，并根据正确诊断为糖尿病的患者比例衡量效果。
糖化血红蛋白（HBA1c）检测的单位成本为6.48美元，空腹血糖（FPG）检测的单位成本为8.39美元。然而，根据空腹血糖（FPG）检测正确诊断的患者比例（96.3%）略高于糖化血红蛋白（HBA1c）检测（96.2%）。糖化血红蛋白（HBA1c）检测的成本效益比为6.74美元，空腹血糖（FPG）检测的成本效益比为8.39美元。每多正确诊断一名糖尿病患者的增量成本效益比为989.06美元。
对于乌干达及类似环境中服务不足的门诊人群，糖化血红蛋白（HBA1c）即时检测可能是空腹血糖（FPG）即时检测更具成本效益的糖尿病筛查替代方法。
