Effectiveness and Cost-Effectiveness of Non-Pharmacological Interventions among Chinese Adults with Prediabetes: A Protocol for Network Meta-Analysis and CHIME-Modeled Cost-Effectiveness Analysis

Abstract

Patients with prediabetes who are at a high risk of progressing to diabetes are recommended early-stage intervention, according to guidelines. Non-pharmacological interventions are effective and cost-effective for glycemic control compared with medicines. We aim to explore which non-pharmacological interventions have the greatest potential effectiveness, cost-effectiveness, and feasibility in community-based diabetes management in China. We will perform a systematic review and network meta-analysis to compare the effectiveness of included non-pharmacological interventions, then use Chinese Hong Kong Integrated Modeling and Evaluation (CHIME) to model the yearly incidence of complications, costs, and health utility for the lifetime. Published studies (only randomized controlled trials (RCTs) and cluster RCTs with at least one study arm of any non-pharmacological intervention) will be retrieved and screened using several databases. Primary outcomes included blood glucose, glycated hemoglobin, incidence of type 2 diabetes mellitus, and achievement of normoglycemia. Health utilities and cost parameters are to be calculated using a societal perspective and integrated into the modified CHIME model to achieve quality-adjusted life-year (QALY) estimates and lifetime costs. QALYs and incremental cost-effectiveness ratio will then be used to determine effectiveness and cost-effectiveness, respectively. Our study findings can inform improved diabetes management in countries with no intervention programs for these patients.

Keywords: China; Chinese Hong Kong Integrated Modeling and Evaluation; cost-effectiveness; non-pharmacological interventions; prediabetes.

Figure 1

Study flow chart.

Figure 2

CHIME economic model. (MI, myocardial infarction; PVD, polyvascular disease; HF, heart failure, IHD, ischemic heart disease; QALY, quality-adjusted life-year; LY, life-year.)