Cost effectiveness of interventions to prevent and control diabetes: A systematic review Open Access

Abstract

Background: Increasing prevalence of diabetes globally and thus increasing cost of diabetes calls for cost effective measures to combat and control this silent killer. We conducted a systematic review to gather updated cost-effectiveness data regarding of interventions for preventing or controlling diabetes and assessed their use in countries of all income brackets.

Methods: We systematically searched three electronic databases (Pubmed, Science Direct and Google Scholar) for articles published between May 2010 and June 1^st, 2013 that included estimates of costs and incremental cost effectiveness ratio (ICER) of interventions to prevent and control diabetes. Estimates from these articles were standardized o 2010 International dollars using exchange rates and inflation rates. Using purchasing power parity adjusted gross domestic product (GDP) per capita for each country, we calculated ceiling ratios for spending levels considered to be cost saving (>GDP per capita), very cost-effective (1-2 times GDP per capita), cost-effective (2-3 times GDP per capita), and not cost-effective (>3 times GDP per capita. The median ICERs for each intervention were then assessed relative to calculated ceiling ratios for countries representing different country-income groups (high income [United States], upper middle [Mexico], lower middle [India] and low income [Kenya]).

Results: We included 27 manuscripts which focused on: lifestyle intervention for individuals with prediabetes or diabetes, metformin intervention prediabetes and blood pressure and blood cholesterol control for individuals with diabetes.

Lifestyle intervention (median ICER= Int$24,597.5/QALY) are cost saving in USA, very cost-effective in Mexico and not cost-effective in India as well as Kenya. Metformin therapy (median ICER = Int$7,638/QALY) is cost saving in USA and Mexico and very cost-effective in India whereas it is not a cost-effective intervention in Kenya. Glucose monitoring (median ICER= Int$40,938/QALY), hypertension and blood cholesterol controlling interventions (median ICER= Int$40,748/QALY) are considered cost saving in USA, cost-effective in Mexico but not cost-effective in India or Kenya.

Conclusion: Despite adjustments to standardize cost effectiveness data, further research and original studies from low-middle income and low-income countries will provide a far better understanding of cost effectiveness of diabetes interventions in these settings.

Table of Contents

Table of Contents

Chapter 1: Introduction: 1

Chapter 2: Methods: 4

Search- 4

Quality Assessment-. 4

Selection: 5

Selection of Countries and their characteristics: 6

Data Analysis: 7

Cost and ICER standardization. 8

Ceiling Ratio Calculation. 11

Chapter 3: Results: 13

Chapter 4: Discussion: 17

Appendix: 21

Figure depicting selection of articles in this review: 21

Abbreviations: 22

Table 1. The 10 item checklist for Quality assessment according to Drummond et al 23

Table 2. Proxy indices. 24

Table 3. Demographic characteristics of selected countries. 25

Table 4. Characteristics of Articles selected for the study. 26

Table 5. Cost components of interventions. 30

Table 6. Ceiling ratio of Cost effectiveness for each country (in International dollars) 35

Table 7. Interpretation and Application of Ceiling Ratios. 36

Charts: 37

Chart 1: Cost effectiveness of Interventions for USA. 37

Chart 2: Cost effectiveness of Interventions for Mexico. 38

Chart 3: Cost effectiveness of Interventions for India. 39

Chart 4: Cost effectiveness of Interventions for Kenya. 40

References: 41

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Low-Middle income country Cost-effectiveness Low income country Diabetes prevention Diabetes control
Committee Chair / Thesis Advisor	Ali, Mohammed K, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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