Health Economic Evaluation of a Diabetes Intervention in Nepal
Background
Type 2 diabetes prevention is a major health issue in low and middle-income countries like Nepal. This study looked into the cost-effectiveness of a health behaviour intervention compared to regular care for managing diabetes in a community setting.
Methods
We randomly assigned 30 groups of patients with type 2 diabetes (481 patients total) to either a health behaviour intervention (238 patients) or usual care (243 patients). The intervention group received:
- Intensive training for diabetes self-management led by community health workers.
- Regular phone calls and ongoing support from peer supporters.
After 6 months, we assessed costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) from a healthcare system perspective. We used 10,000 simulations to analyze the cost-effectiveness under Nepal’s GDP threshold.
Results
Over 6 months, the intervention had:
- An incremental cost of US $28.55 per person.
- An incremental QALY of 0.0085 per person.
- An ICER of US $3,358.82 per QALY gained, which is below the threshold, indicating it is cost-effective.
- A net monetary benefit of US $6.64 per person.
The analysis showed an 89.63% probability that the intervention is cost-effective at the given threshold.
Conclusions
Community-based health behaviour interventions are a cost-effective way to manage type 2 diabetes, providing good value for money. Further studies are needed to explore long-term effects in various low and middle-income countries.
Trial Registration
This trial is registered with the Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819).
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