Cost-effectiveness of community-based interventions for type 2 diabetes management in Indonesia: a time-horizon sensitivity analysis.

Abstract

Background: Type 2 Diabetes Mellitus (T2DM) imposes a severe economic burden on Indonesia's Social Health Insurance Administration Body (BPJS Kesehatan), driven predominantly by expensive late-stage complications. While the Prolanis program offers community-based prevention, a lack of long-term economic forecasting hinders optimal resource allocation among its core interventions. To address this gap, this study aims to evaluate community-based intervention strategies to determine which approach is the most cost-effective for long-term T2DM management in Indonesia.

Methods: We developed a deterministic linear compartmental state-transition model to forecast the 25-year epidemiological and economic impacts of six intervention strategies derived from three Prolanis pillars: health education, physical activity, and lifestyle modification. The model integrated an economic resource allocation framework, Indonesian epidemiology data, and a 3.8-fold complication cost penalty multiplier for complication states. Cost-effectiveness was evaluated from a healthcare payer perspective using the Incremental Cost-Effectiveness Ratio (ICER) and Time-Horizon Sensitivity Analysis.

Results: Over 25 years, the Lifestyle Modification intervention emerged as the dominant strategy compared to baseline care. It generated the highest increase in the managed T2DM population while incurring the lowest total systemic cost. ICER analyses demonstrated that Lifestyle Modification strictly dominated individual and combined promotive activities, which were subject to severe budgetary restrictions due to their high delivery cost-weights. Furthermore, temporal analysis confirmed that Lifestyle Modification achieves systemic net savings rapidly by Year 5. By Year 25, it resulted in projected cumulative net savings of 19.22 trillion IDR under the 3% base-case discount rate, with sensitivity analyses confirming robust dominance across 0% (27.61 trillion IDR savings) and 5% (15.48 trillion IDR savings) discount rates.

Conclusion: Lifestyle Modification is the most economically dominant community-based intervention for managing T2DM in Indonesia. To avert the financial penalties of downstream complications, policymakers should strategically rebalance the Prolanis capitation budget to prioritize proactive, monitoring-driven lifestyle interventions.