{"doi":"10.1111/dme.15074","title":"Cost‐effectiveness of a multicomponent quality improvement care model for diabetes in South Asia: The <scp>CARRS</scp> randomized clinical trial","abstract":"OBJECTIVES: To assess the cost-effectiveness of a multicomponent strategy versus usual care in people with type 2 diabetes in South Asia. DESIGN: Economic evaluation from healthcare system and societal perspectives. SETTING: Ten diverse urban clinics in India and Pakistan. PARTICIPANTS: 1146 people with type 2 diabetes (575 in the intervention group and 571 in the usual care group) with mean age of 54.2 years, median diabetes duration: 7 years and mean HbA1c: 9.9% (85 mmol/mol) at baseline. INTERVENTION: Multicomponent strategy comprising decision-supported electronic health records and non-physician care coordinator. Control group received usual care. OUTCOME MEASURES: Incremental cost-effectiveness ratios (ICERs) per unit achievement in multiple risk factor control (HbA1c <7% (53 mmol/mol) and SBP <130/80 mmHg or LDLc <2.58 mmol/L (100 mg/dL)), ICERs per unit reduction in HbA1c, 5-mmHg unit reductions in systolic BP, 10-unit reductions in LDLc (mg/dl) (considered as clinically relevant) and ICER per quality-adjusted life years (QALYs) gained. ICERs were reported in 2020 purchasing power parity-adjusted international dollars (INT$). The probability of ICERs being cost-effective was considered depending on the willingness to pay (WTP) values as a share of GDP per capita for India (Int$ 7041.4) and Pakistan (Int$ 4847.6). RESULTS: Compared to usual care, the annual incremental costs per person for intervention group were Int$ 1061.9 from a health system perspective and Int$ 1093.6 from a societal perspective. The ICER was Int$ 10,874.6 per increase in multiple risk factor control, $2588.1 per one percentage point reduction in the HbA1c, and $1744.6 per 5 unit reduction in SBP (mmHg), and $1271 per 10 unit reduction in LDLc (mg/dl). The ICER per QALY gained was $33,399.6 from a societal perspective. CONCLUSIONS: In a trial setting in South Asia, a multicomponent strategy for diabetes care resulted in better multiple risk factor control at higher costs and may be cost-effective depending on the willingness to pay threshold with substantial uncertainty around cost-effectiveness for QALYs gained in the short term (2.5 years). Future research needs to confirm the long-term cost-effectiveness of intensive multifactorial intervention for diabetes care in diverse healthcare settings in LMICs.","journal":"Diabetic Medicine","year":2023,"id":383057,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9034,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":344911,"name":"Dimple Kondal","orcid":"0000-0002-1417-9510","position":1,"is_corresponding":false},{"id":1150292,"name":"V Usha Menon","orcid":null,"position":2,"is_corresponding":false},{"id":1149944,"name":"Premlata K Varthakavi","orcid":"0000-0002-4988-3567","position":3,"is_corresponding":false},{"id":299468,"name":"Vijay Viswanathan","orcid":"0000-0001-9116-3937","position":4,"is_corresponding":false},{"id":1150293,"name":"Mala Dharmalingam","orcid":null,"position":5,"is_corresponding":false},{"id":1150294,"name":"Ganapati Bantwal","orcid":null,"position":6,"is_corresponding":false},{"id":1149945,"name":"Rakesh Sahay","orcid":"0000-0002-5471-0695","position":7,"is_corresponding":false},{"id":1149946,"name":"Muhammad Qamar Masood","orcid":"0000-0002-0998-4347","position":8,"is_corresponding":false},{"id":1150295,"name":"Rajesh Khadgawat","orcid":null,"position":9,"is_corresponding":false},{"id":1149947,"name":"Ankush Desai","orcid":"0000-0002-8749-9937","position":10,"is_corresponding":false},{"id":23230,"name":"Dorairaj Prabhakaran","orcid":"0000-0002-3172-834X","position":11,"is_corresponding":false},{"id":245134,"name":"K.M. Venkat Narayan","orcid":"0000-0001-8621-5405","position":12,"is_corresponding":false},{"id":536832,"name":"Victoria Phillips","orcid":"0000-0002-8095-3535","position":13,"is_corresponding":false},{"id":22843,"name":"Nikhil Tandon","orcid":"0000-0003-4604-1986","position":14,"is_corresponding":false},{"id":22946,"name":"Mohammed K. Ali","orcid":"0000-0001-7266-2503","position":15,"is_corresponding":false},{"id":398298,"name":"Kavita Singh","orcid":"0000-0003-4330-666X","position":0,"is_corresponding":true}],"reference_count":27,"raw_metadata":null,"created_at":"2026-07-19T01:17:25.158896Z","pmid":"36815284","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}