Rationale and protocol for estimating the economic value of a multicomponent quality improvement strategy for diabetes care in South Asia

Authors

Kavita Singh, Centre for Chronic Disease Control, C 1/52, Second Floor, Safdarjung Development Area, New Delhi
Mohammed K. Ali, Rollins School of Public Health, Emory University, 1518 Clifton Road, Rm CNR 7041, Atlanta, GA 30322, USA
Raji Devarajan, Centre for Chronic Disease Control, C 1/52, Second Floor, Safdarjung Development Area, New Delhi, 110016, India
Roopa Shivashankar, Centre for Chronic Disease Control, C 1/52, Second Floor, Safdarjung Development Area, New Delhi, 110016, India
Dimple Kondal, Centre for Chronic Disease Control, C 1/52, Second Floor, Safdarjung Development Area, New Delhi, 110016, India
Vamadevan S. Ajay, Centre for Chronic Disease Control, C 1/52, Second Floor, Safdarjung Development Area, New Delhi, 110016, India
V. Usha Menon, Department of Endocrinology & Diabetes, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara P.O., Kochi, Kerala, 682 041, India
Premlata K. Varthakavi, Department of Endocrinology, TNM College & BYL Nair Charity Hospital, Dr. A. L. Nair Road, Mumbai Central, Mumbai, Maharashtra, 400 008, India
Vijay Viswanathan, MV Hospital for Diabetes & Diabetes Research Centre, No 4, West Madha Church Street, Royapuram, Chennai, Tamil Nadu, 600 013, India
Qamar Masood, Aga Khan UniversityFollow

Document Type

Policy Brief

Department

Diabetes/Endocrinology and Metabolism

Abstract

Background: Economic dimensions of implementing quality improvement for diabetes care are understudied worldwide. We describe the economic evaluation protocol within a randomised controlled trial that tested a multi-component quality improvement (QI) strategy for individuals with poorly-controlled type 2 diabetes in South Asia.

Methods/Design: This economic evaluation of the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) randomised trial involved 1146 people with poorly-controlled type 2 diabetes receiving care at 10 diverse diabetes clinics across India and Pakistan. The economic evaluation comprises both a within-trial cost-effectiveness analysis (mean 2.5 years follow up) and a microsimulation model-based cost-utility analysis (life-time horizon). Effectiveness measures include multiple risk factor control (achieving HbA1c < 7% and blood pressure < 130/80 mmHg and/or LDL-cholesterol< 100 mg/dl), and patient reported outcomes including quality adjusted life years (QALYs) measured by EQ-5D-3 L, hospitalizations, and diabetes related complications at the trial end. Cost measures include direct medical and non-medical costs relevant to outpatient care (consultation fee, medicines, laboratory tests, supplies, food, and escort/accompanying person costs, transport) and inpatient care (hospitalization, transport, and accompanying person costs) of the intervention compared to usual diabetes care. Patient, healthcare system, and societal perspectives will be applied for costing. Both cost and health effects will be discounted at 3% per year for within trial cost-effectiveness analysis over 2.5 years and decision modelling analysis over a lifetime horizon. Outcomes will be reported as the incremental cost-effectiveness ratios (ICER) to achieve multiple risk factor control, avoid diabetes-related complications, or QALYs gained against varying levels of willingness to pay threshold values. Sensitivity analyses will be performed to assess uncertainties around ICER estimates by varying costs (95% CIs) across public vs. private settings and using conservative estimates of effect size (95% CIs) for multiple risk factor control. Costs will be reported in US$ 2018.

Discussion: We hypothesize that the additional upfront costs of delivering the intervention will be counterbalanced by improvements in clinical outcomes and patient-reported outcomes, thereby rendering this multi-component QI intervention cost-effective in resource constrained South Asian settings.

Comments

S TUD Y P RO TOCO L

Publication (Name of Journal)

Global health research and policy.

Recommended Citation

Singh, K., Ali, M. K., Devarajan, R., Shivashankar, R., Kondal, D., Ajay, V. S., Menon, V. U., Varthakavi, P. K., Viswanathan, V., Masood, Q. (2019). Rationale and protocol for estimating the economic value of a multicomponent quality improvement strategy for diabetes care in South Asia. Global health research and policy., 4(7).
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_med_diabet_endocrinol_metab/77

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