BACKGROUND:Type 2 Diabetes Mellitus (T2DM) imposes a severe economic burden on Indonesia's Social Health Insurance Administration Body (BPJS Kesehatan), driven predominantly by expensive late-stage complications. While the Prolanis program offers community-based prevention, a lack of long-term economic forecasting hinders optimal resource allocation among its core interventions. To address this gap, this study aims to evaluate community-based intervention strategies to determine which approach is the most cost-effective for long-term T2DM management in Indonesia. METHODS:We developed a deterministic linear compartmental state-transition model to forecast the 25-year epidemiological and economic impacts of six intervention strategies derived from three Prolanis pillars: health education, physical activity, and lifestyle modification. The model integrated an economic resource allocation framework, Indonesian epidemiology data, and a 3.8-fold complication cost penalty multiplier for complication states. Cost-effectiveness was evaluated from a healthcare payer perspective using the Incremental Cost-Effectiveness Ratio (ICER) and Time-Horizon Sensitivity Analysis. RESULTS:Over 25 years, the Lifestyle Modification intervention emerged as the dominant strategy compared to baseline care. It generated the highest increase in the managed T2DM population while incurring the lowest total systemic cost. ICER analyses demonstrated that Lifestyle Modification strictly dominated individual and combined promotive activities, which were subject to severe budgetary restrictions due to their high delivery cost-weights. Furthermore, temporal analysis confirmed that Lifestyle Modification achieves systemic net savings rapidly by Year 5. By Year 25, it resulted in projected cumulative net savings of 19.22 trillion IDR under the 3% base-case discount rate, with sensitivity analyses confirming robust dominance across 0% (27.61 trillion IDR savings) and 5% (15.48 trillion IDR savings) discount rates. CONCLUSION:Lifestyle Modification is the most economically dominant community-based intervention for managing T2DM in Indonesia. To avert the financial penalties of downstream complications, policymakers should strategically rebalance the Prolanis capitation budget to prioritize proactive, monitoring-driven lifestyle interventions.
Abstract Objectives Bacterial vaginosis (BV) is associated with reduced fecundability in women. To address the limited accessibility and diagnostic sensitivity of current preconception BV screening in China, this study evaluated the cost-effectiveness of BV Blue, an accessible, self-administered rapid test. Methods A decision tree model was constructed from a societal perspective to compare five screening strategies: No screening, Amsel criteria, BV Blue testing alone, sequential BV Blue–Nugent testing, and Nugent scoring alone. Effectiveness was defined as the number of pregnancies per 100,000 women over one year. Cost-effectiveness was evaluated using incremental cost-effectiveness ratios (ICERs), referenced against a willingness-to-pay (WTP) threshold based on China’s per capita GDP. Sensitivity analyses were conducted to assess model robustness. Results In a simulated cohort of 100,000 women, BV Blue testing yielded 842 additional pregnancies compared with no screening (ICER: CNY 2,827 per pregnancy), well below the WTP threshold of CNY 99,665. The sequential and Amsel strategies were absolutely dominated by BV Blue testing. Compared with BV Blue testing, Nugent strategy yielded 171 additional pregnancies (ICER: CNY 198,051 per pregnancy), remaining below the three-fold per capita GDP threshold (CNY 298,995). However, sensitivity analyses indicated that the cost-effectiveness of Nugent strategy was not robust, being highly sensitive to BV Blue testing’s diagnostic sensitivity and pregnancy rates. On the cost-effectiveness acceptability curve, BV Blue testing consistently demonstrated the highest probability of being the optimal strategy. Conclusion In the preconception period, all screening strategies yielded more pregnancies than no screening. Both BV Blue testing and Nugent scoring were cost-effective, whereas the Amsel and sequential strategies were not. BV Blue testing is a promising screening tool for preconception BV management. These findings may inform the selection of diagnostic pathways in China’s national preconception screening program.
The pharmaceutical industry plays a pivotal role in the healthcare economy, with drug quality and pricing being critical to consumer welfare. China’s government has implemented National centralized volume-based drug procurement(NVBP) policy, aiming to reduce medication costs through bulk purchasing. While existing research confirms its price-reduction effects, unintended consequences regarding pharmaceutical quality incentives remain overlooked. This study investigates how the NVBP policy reshapes firms’ quality-pricing strategies, addressing a critical gap in policy evaluation. Game-theoretical model is constructed to simulate interactions between two pharmaceutical firms with distinct technological capabilities before and after China’s National volume-based procurement (NVBP) policy. Prior to the policy, the Hotelling model’s spatial competition is reinterpreted as a quality-preference spectrum After the policy, drugs are standardized through consistency evaluation, and competition reduces to pure price competition as in the Bertrand model. Then a double-envelope bidding game is introduced where the government sets a minimum quality standard and firms bid on price. After winning the bid, firms need to decide the production strategy. Before NVBP policy implementation, equal-quality price differences depend solely on technical parameters. Under endogenous quality, a firm’s quality rises with its own technology; the technologically superior firm charges a higher price, but a weaker firm facing a superior rival lowers its price. After NVBP policy implementation, during the bidding time, if both firms pass consistency evaluation, the winning bid price falls, but quality may drop below pre-NVBP levels. If the low-tech firm fails, the high-tech firm gains monopoly pricing power and raises prices. During the production time, some unintended consequences may occur, such as quality risk and supply disruption risk. The implementation of NVBP policy could lower drug prices and improve access, but it may also generate unintended consequences. Low standards induce price competition and reduce quality investment, while high standards may create sole-supplier monopoly. Excessively low bids pose quality or supply risks. Policy should calibrate standards, use tiered incentives, and strengthen surveillance, but empirical validation remains needed.
This study aimed to assess the cost-utility of luseogliflozin compared with Standard of Care (SoC) for patients with T2DM in Vietnam, under two reimbursement scenarios by Vietnam Social Health Insurance (VSHI). A Markov model with five health states was developed to simulate lifetime disease progression. The analysis adopted the VSHI perspective, including only direct medical costs. Health outcomes were expressed as quality-adjusted life-years (QALYs), and cost-effectiveness was evaluated against a willingness-to-pay (WTP) threshold of 1 GDP per capita in Vietnam (USD 4,700 per QALY). Both costs and outcomes were discounted at 3
The present study evaluates the cost-effectiveness of India’s 2019 childhood pneumonia management guidelines compared with no treatment, assuming 100
