Cost-effectiveness analysis of comprehensive intervention programs to control blood glucose in overweight and obese type 2 diabetes mellitus patients based on a real-world setting: Markov modeling

Abstract

Blood glucose control management in overweight and obese diabetic patients poses heavy public health and economic burdens on the health system. This study aimed to evaluate the short-term cost-effectiveness of a comprehensive intervention program for blood glucose management in different groups using a Markov model. Based on real-world data, a Markov model was developed to calculate the cost per quality-adjusted life-year (QALY) gained. The division of Markov states was in accordance with clinical practice. A three-month cycle length and a 5-year time horizon were applied. A 3% discounting rate was applied for both the costs and utilities. The incremental cost-effectiveness ratios (ICER) was more favorable for the male group than the female group, with an associated ICER of 104 K RMB per QALY gained. Compared with the younger group, the incremental gain of the middle-aged group was -0.062 QALY, and the incremental cost was -3,198.64 RMB; meanwhile, the incremental gain of the elderly group was -0.176 QALY, and the incremental cost was 4,485.746 RMB. The sensitivity analysis showed that the ICER is sensitive to the costs of this program and less sensitive to the discounting rate and the time horizon. The comprehensive intervention program for blood glucose management of overweight and obese patients with diabetes is cost-effective for the middle-aged male group and elderly female group, respectively. Moreover, the male group was more favorable than the female group if three times the gross domestic product (GDP) per capita was adopted as the maximum willingness to pay (WTP) for a QALY in China.