Abstract
INTRODUCTION: Indonesia has implemented community-based health intervention (CBHI) to prevent and control type 2 diabetes mellitus (T2D) for over a decade and is in the process of scaling it up to reach a wider population. This study aimed to assess the cost-effectiveness of two CBHI scenarios: community-level T2D screening with or without health education. METHODS: A model-based health economic evaluation, combining a decision tree and Markov model, was used to estimate the lifetime costs and quality-adjusted life years gained and to calculate the incremental cost-effectiveness ratio (ICER) of the two CBHI scenarios compared with a no-intervention. Simulations were run on a hypothetical cohort of 1183 people aged 40 without a prior diabetes diagnosis, from the payer's perspective. Propensity score matching was employed to assess the effectiveness of health education. Data on transition probabilities, utilities, and health state costs were derived from the literature, while CBHI's programme costs came from interviews. Scenario analysis evaluated the impact of repeating interventions over 10 years and varying the levels of CBHI uptake, referral to primary healthcare (PHC) adherence and diabetes knowledge gain needed to achieve cost-effectiveness. Sensitivity analyses assessed input parameter uncertainty. RESULTS: With the current uptake (10.7%) and PHC referral adherence (6.0%), all one-time CBHI scenarios were cost-effective (ICER International dollars (Int$) 3550.28, and Int$8597.46 for T2D screening with or without health education, respectively). Scenario analysis demonstrated that repeated interventions remained cost-effective, and improving referral adherence and health education effectiveness enhanced cost-effectiveness. Sensitivity analysis showed a 60-88% probability that all CBHI scenarios are cost-effective within the 1 gross domestic product per capita threshold, with results being sensitive to cardiovascular disease risk among undiagnosed patients with T2D. CONCLUSION: CBHI scenarios offering T2D screening, with or without health education, are cost-effective. Enhancing coordination with PHC to manage newly detected cases and improving the quality of health education further improve cost-effectiveness. TRIAL REGISTRATION NUMBER: NCT05239572.