Cost-effectiveness of a lifestyle intervention in high-risk individuals for diabetes in a low- and middle-income setting
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RESEARCH ARTICLE
Open Access
Cost-effectiveness of a lifestyle intervention in high-risk individuals for diabetes in a low- and middle-income setting: Trialbased analysis of the Kerala Diabetes Prevention Program Thirunavukkarasu Sathish1,2* , Brian Oldenburg1,3, Kavumpurathu R. Thankappan4,5, Pilvikki Absetz6,7, Jonathan E. Shaw8, Robyn J. Tapp1,9,10, Paul Z. Zimmet11, Sajitha Balachandran4,12, Suman S. Shetty1, Zahra Aziz1,13 and Ajay Mahal1
Abstract Background: Data on the cost-effectiveness of lifestyle-based diabetes prevention programs are mostly from highincome countries, which cannot be extrapolated to low- and middle-income countries. We performed a trial-based cost-effectiveness analysis of a lifestyle intervention targeted at preventing diabetes in India. Methods: The Kerala Diabetes Prevention Program was a cluster-randomized controlled trial of 1007 individuals conducted in 60 polling areas (electoral divisions) in Kerala state. Participants (30–60 years) were those with a high diabetes risk score and without diabetes on an oral glucose tolerance test. The intervention group received a 12month peer-support lifestyle intervention involving 15 group sessions delivered in community settings by trained lay peer leaders. There were also linked community activities to sustain behavior change. The control group received a booklet on lifestyle change. Costs were estimated from the health system and societal perspectives, with 2018 as the reference year. Effectiveness was measured in terms of the number of diabetes cases prevented and quality-adjusted life years (QALYs). Three times India’s gross domestic product per capita (US$6108) was used as the cost-effectiveness threshold. The analyses were conducted with a 2-year time horizon. Costs and effects were discounted at 3% per annum. One-way and multi-way sensitivity analyses were performed. Results: Baseline characteristics were similar in the two study groups. Over 2 years, the intervention resulted in an incremental health system cost of US$2.0 (intervention group: US$303.6; control group: US$301.6), incremental societal cost of US$6.2 (intervention group: US$367.8; control group: US$361.5), absolute risk reduction of 2.1%, and incremental QALYs of 0.04 per person. From a health system perspective, the cost per diabetes case prevented was (Continued on next page)
* Correspondence: [email protected] 1 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia 2 Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton L8L 2X2, ON, Canada Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
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