title: Is diabetes and hypertension screening worthwhile in resource-limited settings? An economic evaluation based on a pilot of a Package of Essential Non-communicable disease interventions in Bhutan.
abstract: In response to a lack of cost-effective data on screening and early treatment of diabetes and hypertension in resource-limited settings, a model-based economic evaluation was performed on the World Health Organization (WHO)'s Package of Essential Non-communicable (PEN) disease interventions for primary health care in Bhutan. Both local and international data were applied in the model in order to derive lifetime costs and outcomes resulting from the early treatment of diabetes and hypertension. The results indicate that the current screening option (where people who are overweight, obese or aged 40 years or older who visit primary care facilities are screened for diabetes and hypertension) represents good value for money compared to 'no screening'. The study findings also indicate that expanding opportunistic screening (70% coverage of the target population) to universal screening (where 100% of the target population are screened), is likely to be even more cost-effective. From the sensitivity analysis, the value of the screening options remains the same when disease prevalence varies. Therefore, applying this model to other healthcare settings is warranted, since disease prevalence is one of the major factors in affecting the cost-effectiveness results of screening programs.
authors.affiliation: Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan, Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Wangchuk
authors.initials: W
authors.lastname: Dukpa
authors.affiliation: Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan, Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand yot.t@hitap.net.
authors.forename: Yot
authors.initials: Y
authors.lastname: Teerawattananon
authors.affiliation: Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan, Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Waranya
authors.initials: W
authors.lastname: Rattanavipapong
authors.affiliation: Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan, Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Varalak
authors.initials: V
authors.lastname: Srinonprasert
authors.affiliation: Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan, Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Watsamon
authors.initials: W
authors.lastname: Tongsri
authors.affiliation: Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan, Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Pritaporn
authors.initials: P
authors.lastname: Kingkaew
authors.affiliation: Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan, Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Jomkwan
authors.initials: J
authors.lastname: Yothasamut
authors.affiliation: Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan, Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Dorji
authors.initials: D
authors.lastname: Wangchuk
authors.affiliation: Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan, Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Tandin
authors.initials: T
authors.lastname: Dorji
authors.affiliation: Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan, Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Kinzang
authors.initials: K
authors.lastname: Wangmo
mesh_terms: D001631:Bhutan / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology; D006295:Health Resources / Q000191:economics; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology; D008403:Mass Screening / Q000191:economics*; D018803:Models, Economic; D015995:Prevalence; D011320:Primary Health Care / Q000191:economics
keywords: Bhutan; Package of Essential Non-communicable disease interventions (PEN); cost-effectiveness analysis; diabetes mellitus; hypertension; non-communicable diseases