OBJECTIVES

This paper explores the long-term cost-effectiveness of differently delivered prevention interventions in pre-diabetic participants with impaired glucose tolerance (IGT) in Bangladesh.

METHODS

A Markov model was developed to compare three interventions, based on mHealth mobile phone messaging, community mobilisation and primary care facilities, relative to no intervention. The lifetime model simulated four states (normoglycaemia, IGT, T2DM and death) through 50 one-year cycles while using input parameters from the DMagic trial and other published data. Primary outcomes included the costs from a provider perspective, quality-adjusted life-years gained, incremental cost-effectiveness ratios (ICERs) and incidence of T2DM. Deterministic and probabilistic sensitivity analyses were performed to reflect parameter and model uncertainty

RESULTS

In the base-case, the community intervention yielded, on one hand, substantial reductions in diabetes incidence with only 25% of the IGT population developing T2DM (versus 46% in the no intervention arm). On the other, it was also the most cost-effective strategy with an ICER of 168 INT$ per QALY gained, relative to no intervention. This was followed by the mHealth intervention which revealed limited effectiveness at low cost, leading to an ICER of 189 INT$ per QALY gained. The facility intervention with an ICER of 400 INT$ per QALY gained produced greater health benefits, was yet more costly. In comparison, the community intervention was the optimal decision at lately developed cost-effectiveness thresholds for Bangladesh. At willingness-to-pay ranges between approximately 3% and 45% of 2017 GDP per capita, the community intervention demonstrated up to 90% probability of being cost-effective.

CONCLUSIONS

Participatory community mobilisation is a low-cost, effective strategy to reduce the burden of T2DM, offering good value for money in preventing a significant non-communicable disease. Translation of these findings into policy and practice alongside rigorous monitoring and evaluation is important in light of the critical necessity to set diabetes as a public health priority in Bangladesh.