Health economic evaluation alongside randomised clinical trial of a health behaviour intervention to manage type 2 diabetes in Nepal  

作　　者：Padam Kanta Dahal Zanfina Ademi Lal Rawal Rashidul Alam Mahumud Grish Paudel Biraj Karmacharya Haruka Sakamoto Tomohiko Sugishita Corneel Vandelanotte 

机构地区：[1]School of Health,Medical and Applied Sciences,Central Queensland University,Sydney Campus,Sydney,NSW,Australia [2]Appleton Institute,Physical Activity Research Group,Central Queensland University,Rockhampton,QLD,Australia [3]Health Economics and Policy Evaluation Research(HEPER)Group,Centre for Medicine Use and Safety,Faculty of Pharmacy and Pharmaceutical Sciences,Monash University,Melbourne,Australia [4]School of Public Health and Preventive Medicine,Monash University,Melbourne,Australia [5]Translational Health Research Institute(THRI),Western Sydney University,Sydney,NSW,Australia [6]NHRMC Clinical Trials Centre,Faculty of Medicine and Health,The University of Sydney,Camperdown,NSW,Australia [7]Department of Community Medicine,Kathmandu University Hospital,Dhulikhel,Nepal [8]Section of Global Health,Department of Hygiene and Public Health,Tokyo Women’s Medical University,Tokyo,Japan

出　　处：《Global Health Research and Policy》2024年第1期21-31,共11页全球健康研究与政策(英文)

基　　金：This research project was supported through the Japanese Agency for Medical Research and Development(AMED)under the Global Alliance for Chronic Disease(GACD)call funding mechanism(#SU13,2019-2023,Grant number JP21jk0110020).

摘　　要：Background Prevention of type 2 diabetes is becoming an urgent public health concern in low and middle-income countries(LMICs).However,there is currently no evidence of a cost-effective approach of health behaviour interventions from community settings in low-income countries like Nepal.Therefore,this study aimed to assess the withintrial economic evaluation of a health behaviour intervention compared with usual care for managing type 2 diabetes in a community setting in Nepal.Methods We randomly assigned 30 clusters comprising 481 patients with type 2 diabetes of which 15 to a health behaviour intervention(n=238 patients)and 15 to the usual care(n=243 patients).Patients in the intervention group received community health workers-led intensive training for diabetes self-management along with regular phone calls and ongoing support from peer supporters.Costs,quality-adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER)as costs per QALYs gained were assessed after 6-month from a healthcare system perspective.Probabilistic sensitivity analysis was conducted using 10,000 Monte Carlo simulations to assess the impact of uncertainty of cost-effectiveness analysis under the threshold of three times gross domestic product(GDP)per capita for Nepal(i.e.,US$4,140).Results Over the 6-month,the intervention yielded an incremental cost of US$28.55(95%CI=US$21.26 to US$35.84)per person and an incremental QALYs of 0.0085(95%CI=-0.0106 to 0.0275)per person.The ICER associated with the health behaviour intervention was US$3,358.82(95%CI=US$-2005.66 to US$3,974.54)per QALY gained,which was below the estimated threshold,indicating a cost-effective approach with a net monetary benefit of US$6.64(95%CI=US$-22.62 to US$78.01).Furthermore,the probabilistic sensitivity analysis consisting of 10,000 Monte Carlo simulations indicates that the intervention being cost-effective at the given threshold was 89.63%.Conclusions Health behaviour interventions in community settings are a cost-effective approach to manage type 2 di

关 键 词：COST-EFFECTIVENESS Economic evaluation Health behaviour interventions Type 2 diabetes 

分 类 号：R58[医药卫生—内分泌]