Evidence mapPaperPMID 39690410Full record

Trial reportGlobal health research and policy2024

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

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

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in Global health research and policy, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Padam Kanta DahalSchool of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, NSW, Australia. padamdahal1@gmail.com.ORCID http://orcid.org/0000-0002-5978-3762
Zanfina AdemiHealth Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
Lal RawalSchool of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, NSW, Australia.
Rashidul Alam MahumudNHRMC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
Grish PaudelSchool of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, NSW, Australia.
Biraj KarmacharyaDepartment of Community Medicine, Kathmandu University Hospital, Dhulikhel, Nepal.
Haruka SakamotoSection of Global Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan.
Tomohiko SugishitaSection of Global Health, Department of Hygiene and Public Health, Tokyo Women's Medical University, Tokyo, Japan.
Corneel VandelanotteAppleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPrevention 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 within-trial economic evaluation of a health behaviour intervention compared with usual care for managing type 2 diabetes in a community setting in Nepal.

methodsWe 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).

resultsOver 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%.

conclusionsHealth behaviour interventions in community settings are a cost-effective approach to manage type 2 diabetes, offering good value for money. However, more studies focused on long-term follow-up across diverse setting of LMICs should be warranted to assess the maximum impact of such interventions.

trial registrationAustralia and New Zealand Clinical Trial Registry (ACTRN12621000531819) Registered on 6

Indexed as

Cost-Benefit AnalysisDiabetes Mellitus, Type 2Health BehaviorAdultAgedFemaleHumansMaleMiddle AgedNepalQuality-Adjusted Life YearsCost-effectivenessEconomic evaluationHealth behaviour interventionsType 2 diabetes

Identifiers

PMID39690410
PMCPMC11650842

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.