Abstract
Introduction: By means of using a risk assessment and screening system among people at risk of developing diabetes mellitus or people with pre-diabetes, there are many tools and each has advantages or limitations in diagnosing diabetes mellitus and predicting future diabetes. There are also different operating costs in relation with economic evaluation including of budget impact analysis or budget burdens and the feasibility analysis of diabetes mellitus screening in communities and service facilities. Therefore, it is necessary and important to take urgent action in order to provide guidelines for determining a cost-effective diabetes mellitus screening process. It could be appropriated for budget allocation and it is feasible. Data/information and research results will be presented to relevant agencies for consideration to inform policy in applying the screening through the aforementioned study whether it should be included in the benefit package and can be applied to support health system in the context of Thailand.
Objectives: To evaluate cost-utility analysis, budget impact analysis using societal and government perspectives, including the feasibility study of diabetes screening measures in the Thai population.
Methodology: Cost-utility analysis using a decision tree and Markov model was performed to simulate the costs and utilities and to estimate the budget impact of type 2 diabetes mellitus screening in the Thai population. All parameters were obtained from published studies. Lifetime horizon was applied with both costs and outcomes discounted by 3%, as recommended by the guidelines of economic evaluation in Thailand. One way and probabilistic sensitivity analyses were conducted to examine the uncertainty of input parameters. Alternative measures for screening diabetes mellitus in the Thai population include (1) no screening and treatment for diabetes; (2) screening for diabetes in the general population aged 35-59 years, consisting of an assessment of the risk of developing diabetes by Use Thai Diabetes Risk Score (DMRS), blood sugar testing by finger prick (Fasting Capillary Blood Glucose: FCBG) or measurement of plasma glucose in blood drawn from a vein (Fasting Plasma Glucose: FPG). (3) people with pre-diabetes, those with a fasting blood sugar level between 110-125 mg/dl will undergo an Oral Glucose Tolerance Test (OGTT). For the study to evaluate the feasibility of diabetes screening measures, it was done in 3 groups of service recipients: (1) those at risk for diabetes. (People with a risk score ≥ 6 points or one of the risk factors for diabetes); (2) people with pre-diabetes (with a fasting sugar level of 110-125 mg/dl) and (3) diabetic patients (has a fasting blood sugar level ≥ 126 mg/dl and has been diagnosed by a doctor) and service providers in public health facilities in the community rely on the 3A principles: Availability, Accessibility, and Affordability. And there is a study of the path of diabetic patients by applying the RRTTR measure.
Results: Incremental cost-effectiveness ratio (ICER) of DMRS screening in the general population. Screening with OGTT in people with pre-diabetes (glucose levels 110-125 mg/dl) compared to no screening. With the specified model in Markov analysis, the value is equal to THB 157,570 per QALY and equal to THB 114,097 per QALY, respectively. At the willingness to pay (WTP) THB 160,000 per QALY gained. It has been shown that screening with OGTT in both at-risk groups and those with pre-diabetes. It has an economic value (ICERs) equal to 91.70% from Probabilistic Sensitivity Analysis (PSA) simulation of 1,000 cycles under the Willingness to pay (WTP) criterion of THB 160,000/QALYs. Therefore, it can be seen that testing with OGTT in both groups at risk and groups with pre-diabetes were cost-effectiveness in the context of Thailand.
Budget impacts analysis arising from screening for diabetes in high-risk groups/people with pre-diabetes. Budget estimates for diabetes screening measures and the cost of diabetes treatment and complications in the 5-year period (2023 - 2027) from the estimation of the population aged 35-59 years (male and female), there is a budget impact to be used for diabetes screening with OGTT of approximately 130 million baht in 2023 and approximately 131 million baht in 2027. And when combined with the cost of other screening methods, this makes the cost for screening by other methods combined and OGTT equal to 3,644 million baht in 2023 and 3,658 million baht in 2027.
For the results of the feasibility study of diabetes screening measures in the Thai population by interviewing both service recipients and service providers based on three issues (3As): Availability, Accessibility, and Affordability. Affordability found that the availability of OGTT services from the perspective of service recipients and service providers was 63.9 percent and 60.0 percent, respectively. The accessibility of OGTT services from the perspective of service recipients and service providers was 26.0 percent
and 63.3 respectively and the ability to pay OGTT from the perspective of service recipients and service providers equal to 89.71 percent and 66.67 percent, respectively. The results are similar to other screening methods. For the study of the patient journey (DM Patient Journey) which was applied from the Reach – Recruit – Test – Treat – Retain (RRTTR) measure. It was found that there were two problems: Registration in the service system was 72.7 percent from the point of view of service recipients and issues from the point of view of service providers. It was found that only 68.2 percent of diabetic patients received treatment, which was caused by working other provinces, no one or no car to deliver to services, lack of awareness of the severity, forgetting the appointment date, having the same medicine left over, and being busy. There are only a few causes of this, i.e. go for treatment at a private clinic or hospital, sick with another disease and buy and take medicine from drug store.
