Economic Evaluation of Adopting a Risk Score for Diabetes Screening in Indonesia.

OBJECTIVES: To date, no studies have evaluated the cost-effectiveness of adopting a risk score to detect undiagnosed diabetes in Indonesia. This study aimed to compare the cost-effectiveness of 3 approaches: (1) no screening; (2) the random capillary blood glucose (RCBG) strategy, the current initial screening method with 32.8% coverage; and (3) the Finnish Diabetes Risk Score (FINDRISC) strategy, as an initial screening tool in complement to the RCBG strategy. METHODS: A decision tree and Markov hybrid model was used to analyze a hypothetical population aged 45 years at the time of screening. Incremental cost-effectiveness ratio (ICER) value was calculated from the payer's perspective using a lifetime horizon. The diagnostic accuracy of the FINDRISC was calculated based on the National Basic Health Survey, whereas other data were derived from the literature. RESULTS: Compared with no screening, both the RCBG and FINDRISC strategies were cost-effective, with FINDRISC strategy showing a slightly lower ICER of $1687 per quality-adjusted life-years (QALY) compared with $1718 per QALY for RCBG strategy. When directly compared with the RCBG strategy, the FINDRISC strategy had an ICER of $1646 per QALY. Scenario analysis indicated that screening every 3 or 5 years resulted in lower ICER values compared with the base-case analysis, whereas implementing effective interventions for prediabetes yielded the lowest ICER. CONCLUSIONS: Adopting the FINDRISC strategy to enhance the coverage of diabetes screening programs is cost-effective from the payer's perspective compared with the no screening or RCBG strategy in Indonesia.