Integrated diabetes care delivery at primary healthcare facilities in Pakistan: An economic evaluation of a pragmatic randomized controlled trial

Abstract Background: In Pakistan approximately 7 million people were living with diabetes in 2014. To address the burden of diabetes, a randomized controlled trial was conducted to evaluate the effectiveness of a standardized care package in improving diabetes outcomes in health care settings of Punjab, Pakistan. A costing study was embedded within this RCT to estimate the cost-effectiveness of the standardized diabetes care package in improving diabetes outcomes. Methods: 166 patients were recruited for the costing study from 14 public health clusters in Sargodha district of Pakistan. Analyses was conducted using the societal perspective, broader societal perspective and sensitivity analyses to explore the uncertainty in analyses. Data was analysed for both 166 participants enrolled in costing study and for the 495 participants recruited in the cRCT, using multiple amputations. Results: Using the societal perspective, standardized diabetes care package was found to be cost-effective as compared to the standardized care and was cost saving as the costs in the intervention arm were lower than those in the control arm whereas greater effects were demonstrated in the intervention arm. As per the broader societal perspective and the healthcare perspective only, the standardized care package was not proven to be cost-effective. Keywords: Diabetes management, health services cost, out of pocket cost, cost-effectiveness.