Cost-effectiveness of diabetes screening and diagnosis services for people with TB in the Philippines

Aim:
Tuberculosis (TB) remains a leading cause of death in low- and middle-income countries, and diabetes is a known risk factor for progression to active TB disease. While the Philippines national strategic plan for TB aims to screen 90 % of TB cases for diabetes, the cost-effectiveness of screening is not well known.

Methods:
We constructed a decision tree model to assess the cost-effectiveness of providing diabetes testing for 90% of people with an unknown diabetes status at their TB diagnosis and subsequent routine diabetes care, compared to the scenario of providing TB treatment only. Cost-effectiveness of the intervention was assessed from the provider and societal perspectives.

Results:
The intervention was cost saving. At a willingness to pay threshold per disability-adjusted-life-year of 50 % of gross domestic product per capita, the probability of the intervention being cost saving was 99 % from the provider and societal perspectives in people aged ≥18 years. The probability was highest in people with BMI >18.5 kg/m2 and in those aged >45 years.

Conclusion:
Our findings suggest that providing diabetes care for people with TB will be cost saving, and the intervention is likely to be most cost saving in people with BMI >18.5 kg/m2 or those aged >45 years.