Cost-Effectiveness of Population Screening Programs for Cardiovascular Diseases and Diabetes in Low- and Middle-Income Countries: A Systematic Review

Sharma, Manushi; John, Renu; Afrin, Sadia; Zhang, Xinyi; Wang, Tengyi; Tian, Maoyi; Sahu, Kirti Sundar; Mash, Robert; Praveen, Devarsetty; Saif‐Ur‐Rahman, K. M.

doi:10.3389/fpubh.2022.820750

Cited by 5 publications

(1 citation statement)

References 45 publications

(194 reference statements)

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“…Concerning the cost-effectiveness of performing 1 h afterload glucose in obese subjects as a screening strategy to identify prediabetes, the data are heterogeneous as the success of a screening program depends on the context (epidemiology, social factors, political priorities, and budget constraints). A recent literature review shows that more cost-effective evaluations of national and regional prevention programs for non-communicable diseases are needed to guide policymakers [43]. We believe that good clinical practice would be to implement screening for young people at risk for prediabetes and lifestyle modification through improved nutrition and exercise.…”

Section: Discussionmentioning

confidence: 99%

One-Hour Post-Load Plasma Glucose and Altered Glucometabolic Profile in Youths with Overweight or Obesity

Bonito¹,

Valerio

Licenziati

et al. 2023

IJERPH

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In youths, two cut-offs (133 and 155 mg/dL) have been proposed to identify high glucose levels at the 1 h (G60) mark during an oral glucose tolerance test (OGTT). We evaluated which cut-off was more closely associated with isolated impaired glucose tolerance (IGT) and cardiometabolic risk (CMR) in 1199 youth with overweight/obesity (OW/OB) and normal fasting glucose and/or HbA1c. The disposition index (DI) was available in 724 youths. The sample was divided by two cut-offs of G60: <133 mg/dL (n = 853) and ≥133 mg/dL (n = 346), or G60 < 155 mg/dL (n = 1050) and ≥155 mg/dL (n = 149). Independent of the cut-off, youths with high levels of G60 showed higher levels of G120, insulin resistance (IR), triglycerides to HDL ratio (TG/HDL), alanine aminotransferase (ALT), and lower insulin sensitivity (IS) and DI than youths with lower levels of G60. The percentage of youths showing IGT, IR, low IS, high TG/HDL ratio, high ALT, and low DI was 50% higher in the G60 ≥ 133 mg/dL group than in the G60 ≥ 155 mg/dL one. In youths with OW/OB and IGT, a cut-off of G60 ≥ 133 mg/dL is more useful than G60 ≥ 155 mg/dL to identify those at high risk of IGT and altered CMR profile.

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Section: Discussionmentioning

confidence: 99%

One-Hour Post-Load Plasma Glucose and Altered Glucometabolic Profile in Youths with Overweight or Obesity

Bonito¹,

Valerio

Licenziati

et al. 2023

IJERPH

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Optimizing cardiovascular disease risk screening in a low-resource setting: cost-effectiveness of program modifications in Sri Lanka modelled with nationally representative survey data

Wijemunige,

Rannan-Eliya,

van Baal

et al. 2023

BMC Public Health

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Background While screening for cardiovascular disease (CVD) risk can help low-resource health systems deliver low-cost, effective prevention, evidence is needed to adapt international screening guidelines for maximal impact in local settings. We aimed to establish how the cost-effectiveness of CVD risk screening in Sri Lanka varies with who is screened, how risk is assessed, and what thresholds are used for prescription of medicines. Methods We used data for people aged 35 years and over from a 2018/19 nationally representative survey in Sri Lanka. We modelled the costs and quality adjusted life years (QALYs) for 128 screening program scenarios distinguished by a) age group screened, b) risk tool used, c) definition of high CVD risk, d) blood pressure threshold for treatment of high-risks, and e) prescription of statins to all diabetics. We used the current program as the base case. We used a Markov model of a one-year screening program with a lifetime horizon and a public health system perspective. Results Scenarios that included the WHO-2019 office-based risk tool dominated most others. Switching to this tool and raising the age threshold for screening from 35 to 40 years gave an incremental cost-effectiveness ratio (ICER) of $113/QALY. Lowering the CVD high-risk threshold from 20 to 10% and prescribing antihypertensives at a lower threshold to diabetics and people at high risk of CVD gave an ICER of $1,159/QALY. The findings were sensitive to allowing for disutility of daily medication. Conclusions In Sri Lanka, CVD risk screening scenarios that used the WHO-2019 office-based risk tool, screened people above the age of 40, and lowered risk and blood pressure thresholds would likely be cost-effective, generating an additional QALY at less than half a GDP per capita.

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Associations of work characteristics with obesity, behavioral risk factors and NCDs in Bangkok, Thailand

Nasueb,

Kosiyaporn,

Cetthakrikul

et al. 2024

PLOS Glob Public Health

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Non-communicable diseases (NCDs) are one of the premature causes of death in Thailand especially among working age group. This study aims to examine the associations between work characteristics and NCDs, obesity, and behavioral risk factors in Bangkok, the Capital of Thailand. This study employed secondary data analysis of cross-sectional data from the Health Behavior of Population Survey 2021 by the National Statistical Office (NSO). The respondents who were 15–60 years old and resided in Bangkok were included in this study (n = 4,925). The data were analyzed by descriptive statistics of work characteristics, and multiple logistic regression between working groups and behavioral risks adjusted with other demographic and socioeconomic variables. The study found that all workers showed a lower likelihood of reporting NCDs compared to the unemployed. Professional/administrative/managerial workers had 44% less chances of reporting NCDs compared to unemployed (AOR = 0.56; 95%CI = 0.43–0.75; P-value <0.001. All working groups showed a significant association with alcohol consumption, smoking, and dietary intake. In particular, skilled, semi-skilled, unskilled workers, technicians, clerks, and service or sales workers were more likely to smoke and drink alcohol compared to those who were unemployed. Nevertheless, work characteristics did not affect the likelihood of inappropriate fruit and vegetable intake, insufficient physical activity, and sedentary behavior. The study found a link between work characteristics and NCDs in the working-age population, identifying specific work characteristics associated with behavioral risk factors such as alcohol consumption, smoking, and high dietary risk. The findings suggest a need for NCD prevention strategies targeting diverse workplaces such as smoking regulations, healthy canteens, and promoting opportunities for physical activity, with a regulatory focus on labor laws and policy incentives. Finally, disaggregated occupational data should be emphasis for effective monitoring and evaluation in NCD policy.

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Cost-Effectiveness of Population Screening Programs for Cardiovascular Diseases and Diabetes in Low- and Middle-Income Countries: A Systematic Review

Cited by 5 publications

References 45 publications

One-Hour Post-Load Plasma Glucose and Altered Glucometabolic Profile in Youths with Overweight or Obesity

One-Hour Post-Load Plasma Glucose and Altered Glucometabolic Profile in Youths with Overweight or Obesity

Optimizing cardiovascular disease risk screening in a low-resource setting: cost-effectiveness of program modifications in Sri Lanka modelled with nationally representative survey data

Associations of work characteristics with obesity, behavioral risk factors and NCDs in Bangkok, Thailand

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