Abstract
The objective of this quasi-experimental research was to apply the Thai diabetes
risk score for evaluating diabetes prevention outcome in order to conduct a cost-effectiveness
analysis of diabetes primary prevention for prediabetes. The study population
included 1,182 cases of prediabetes selected by verbal screening criteria and impaired
fasting glucose level (100 - 125 mg/dl); they were divided into two study groups for
comparison. The experimental group consisted of 400 prediabetes cases who agreed to
participate in a prediabetic day camp; the control group comprised 410 prediabetes cases
receiving ordinary health-care services. The instruments used for collecting the data were
questionnaires, Thai diabetes risk score, customer and provider cost data recording profiles,
practice guidelines for a diabetes prevention program in a day camp. Data were
analyzed statistically, using frequency, percentage, mean, standard deviation, and ratio;
they were comparatively analyzed by t-test and paired t-test at the 0.05 level of statistical
significance.
The results of this study were as follows: (1) prediabetic day camp activities effected
a reduction in the cumulative incidence of developing diabetes by a factor of 7.49 times in
the experimental group (relative risk = 7.49) compaired with the control group; it also
statistically significantly decreased the average diabetes risk score and the probability
level of the sample in the day camp compared with those in the control group. Furthermore,
the risk factors for diabetes reduced from lifestyle modification caused a statistical
decrease that was significant (p < 0.05) on both average BMI and BP level, except for
waist circumference; (2) the effectiveness of diabetes primary prevention for prediabetes
justified by summation of the individual differences in diabetes risk probability before
and after intervention was 0.0198; otherwise the cumulative incidence of lower diabetes
risk score for prediabetes in the experimental group revealed a score of 0.2375; (3) the
economic cost of diabetes primary prevention for prediabetes in the prediabetic day camp
was 357,100 Baht, with the opportunity cost being 20.31 percent compared with the total
cost; (4) the cost-effectiveness ratio of diabetes primary prevention for prediabetes in the
day camp was 18,035,353 Baht per effective diabetes risk probability prevented and/or
1,503,578.9 Baht per effective cumulative incidence prevented.
It was recommended that (1) the research findings should provide important information
for policy decisions to apply the Thai diabetes risk score for evaluating diabetes
prevention outcome; (2) comparative cost-effectiveness analysis of diabetes primary prevention
for prediabetes should also be studied by other health-care teams on a long-term
basis.
