Cost-effectiveness of behavioural counselling intervention compared with non-intervention for adult patients with metabolic syndrome to prevent cardiovascular diseases and type 2 diabetes in Japan: a microsimulation modelling study.

Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE

Original Publication: [London] : BMJ Publishing Group Ltd, 2011-

Diabetes Mellitus, Type 2*/prevention & control ; Diabetes Mellitus, Type 2*/drug therapy ; Cardiovascular Diseases*/prevention & control ; Metabolic Syndrome*/prevention & control; Adult ; Humans ; Japan ; Cost-Benefit Analysis ; Counseling ; Quality-Adjusted Life Years

Objectives: Nationwide lifestyle intervention-specific health guidance (SHG) in Japan-employs counselling and education to change unhealthy behaviours that contribute to metabolic syndrome, especially obesity or abdominal obesity. We aimed to perform a model-based economic evaluation of SHG in a low participation rate setting.
Design: A hypothetical population, comprised 50 000 Japanese aged 40 years who met the criteria of the SHG, used a microsimulation using the Markov model to evaluate SHG's cost-effectiveness compared with non-SHG. This hypothetical population was simulated over a 35-year time horizon.
Setting: SHG is conducted annually by all Japanese insurers.
Outcome Measures: Model parameters, such as costs and health outcomes (including quality-adjusted life-years, QALYs), were based on existing literature. Incremental cost-effectiveness ratios were estimated from the healthcare payer's perspective. Deterministic and probabilistic sensitivity analyses (PSA) were conducted to evaluate the uncertainty around the model input parameters.
Results: The simulation revealed that the total costs per person in the SHG group decreased by JPY53 014 (US$480) compared with that in the non-SHG group, and the QALYs increased by 0.044, wherein SHG was considered the dominant strategy despite the low participation rates. PSA indicated that the credibility intervals (2.5th-97.5th percentile) of the incremental costs and the incremental QALYs with the SHG group compared with the non-SHG group were -JPY687 376 to JPY85 197 (-US$6226 to US$772) and -0.009 to 0.350 QALYs, respectively. Each scenario analysis indicated that programmes for improving both blood pressure and blood glucose levels among other risk factors for metabolic syndrome are essential for improving cost-effectiveness.
Conclusions: This study suggests that even small effects of counselling and education on behavioural modification may lead to the prevention of acute life-threatening events and chronic diseases, in addition to the reduction of medication resulting from metabolic syndrome, which results in cost savings.
Competing Interests: Competing interests: YMN reports a study grant from Bayer, outside the submitted work. No other disclosures are applicable.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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Keywords: HEALTH ECONOMICS; Obesity; PUBLIC HEALTH

Date Created: 20240405 Date Completed: 20240408 Latest Revision: 20240411

20240411

PMC11002415

10.1136/bmjopen-2023-072688

38580368