Understanding the cost-effectiveness of diabetes prevention programmes to reduce type 2 diabetes (T2DM) is important for health policy making and priority setting in Bangladesh. This paper explores the long-term cost-effectiveness of a community-based lifestyle intervention in patients with impaired glucose tolerance (IGT).

METHODS

A Markov model was developed to compare the cost-effectiveness of a community mobilisation programme to a control group with no intervention. Effectiveness and cost parameters were primarily derived from the Bangladesh DMagic trial, but also from other international intervention trials. While a 50-year time horizon was taken, the course of patients along four health states was simulated (normoglycaemia, IGT, T2DM, and death). A provider (health system) perspective was adopted and individual-level incremental analysis undertaken.

RESULTS : The incremental costs of the community intervention amounted to 142 international dollars (INT$) while the incremental quality-adjusted life-years (QALY) gained were estimated to be 0.85. Therefore, the incremental cost-effectiveness ratio was 168 INT$/QALY gained, relative to no intervention. Applying the willingness-to-pay-thresholds of the WHO (one to three times GDP per capita) revealed that the community intervention was highly cost-effective. The intervention also led to substantial reductions in diabetes incidence with only one quarter of the IGT population developing T2DM. The robustness of the results was confirmed in the sensitivity analysis.

CONCLUSIONS

This analysis suggests that Bangladesh policy should consider community mobilisation through participatory learning and action as a cost-effective intervention to prevent diabetes. Modelling the costs and effects of other diabetes prevention programmes in the Bangladesh context are needed for cross-comparison.