{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T11:32:07Z","timestamp":1762342327842,"version":"3.37.3"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2024,8,3]],"date-time":"2024-08-03T00:00:00Z","timestamp":1722643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000269","name":"UK Economic and Social Research Council","doi-asserted-by":"crossref","award":["MR\/M014290\/1"],"award-info":[{"award-number":["MR\/M014290\/1"]}],"id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001321","name":"National Research Foundation","doi-asserted-by":"publisher","award":["UID 129506"],"award-info":[{"award-number":["UID 129506"]}],"id":[{"id":"10.13039\/501100001321","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["MR\/M014290\/1; Myers"],"award-info":[{"award-number":["MR\/M014290\/1; Myers"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000269","name":"UK Economic and Social Research Council","doi-asserted-by":"crossref","award":["MR\/M014290\/1"],"award-info":[{"award-number":["MR\/M014290\/1"]}],"id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001321","name":"National Research Foundation","doi-asserted-by":"publisher","award":["UID 129506"],"award-info":[{"award-number":["UID 129506"]}],"id":[{"id":"10.13039\/501100001321","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["MR\/M014290\/1; Myers"],"award-info":[{"award-number":["MR\/M014290\/1; Myers"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Type 2 diabetes (T2D) represents a growing disease burden in South Africa. While glycated haemoglobin (HbA1c) testing is the gold standard for long-term blood glucose management, recommendations for HbA1c monitoring frequency are based on expert opinion. This study investigates the effectiveness and cost-effectiveness of alternative HbA1c monitoring intervals in the management of T2D. A Markov model with three health states (HbA1c &amp;lt;7%, HbA1c\u2009\u2265\u20097%, Dead) was used to estimate lifetime costs and quality-adjusted life years (QALYs) of alternative HbA1c monitoring intervals among patients with T2D, using a provider\u2019s perspective and a 3% discount rate. HbA1c monitoring strategies (three-monthly, four-monthly, six-monthly and annual tests) were evaluated with respect to the incremental cost-effectiveness ratio (ICER) assessing each comparator against a less costly, undominated alternative. The scope of costs included the direct medical costs of managing diabetes. Transition probabilities were obtained from routinely collected public sector HbA1c data, while health service utilization and health-related-quality-of-life (HRQoL) data were obtained from a local cluster randomized controlled trial. Other parameters were obtained from published studies. Robustness of findings was evaluated using one-way and probabilistic sensitivity analyses. A South African indicative cost-effectiveness threshold of USD2665 was adopted. Annual and lifetime costs of managing diabetes increased with HbA1c monitoring, while increased monitoring provides higher QALYs and life years. For the overall cohort, the ICER for six-monthly vs annual monitoring was cost-effective (USD23 22.37 per QALY gained), whereas the ICER of moving from six-monthly to three-monthly monitoring was not cost effective (USD6437.79 per QALY gained). The ICER for four-monthly vs six-monthly monitoring was extended dominated. The sensitivity analysis showed that the ICERs were most sensitive to health service utilization rates. While the factors influencing glycaemic control are multifactorial, six-monthly monitoring is potentially cost-effective while more frequent monitoring could further improve patient HrQoL.<\/jats:p>","DOI":"10.1093\/heapol\/czae072","type":"journal-article","created":{"date-parts":[[2024,8,3]],"date-time":"2024-08-03T19:23:14Z","timestamp":1722712994000},"page":"946-955","source":"Crossref","is-referenced-by-count":2,"title":["Comparing the effectiveness and cost-effectiveness of alternative type 2 diabetes monitoring intervals in resource limited settings"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3930-3389","authenticated-orcid":false,"given":"Elton","family":"Mukonda","sequence":"first","affiliation":[{"name":"Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town , Anzio Road, Cape Town 7925,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maia","family":"Lesosky","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London , 1B Manresa Road, London SW3 6LR,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siphesihle","family":"Sithole","sequence":"additional","affiliation":[{"name":"Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town , Anzio Road, Cape Town 7925,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diederick J","family":"van der Westhuizen","sequence":"additional","affiliation":[{"name":"Division of Chemical Pathology, Department of Pathology, University of Cape Town , Anzio Road, Observatory, Cape Town 7925,","place":["South Africa"]},{"name":"National Health Laboratory Service, Groote Schuur Hospital , Main Road, Observatory, Cape Town 7935,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jody A","family":"Rusch","sequence":"additional","affiliation":[{"name":"Division of Chemical Pathology, Department of Pathology, University of Cape Town , Anzio Road, Observatory, Cape Town 7925,","place":["South Africa"]},{"name":"National Health Laboratory Service, Groote Schuur Hospital , Main Road, Observatory, Cape Town 7935,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naomi S","family":"Levitt","sequence":"additional","affiliation":[{"name":"Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town , Observatory, Cape Town 7925,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0235-6716","authenticated-orcid":false,"given":"Bronwyn","family":"Myers","sequence":"additional","affiliation":[{"name":"Curtin enAble Institute, Faculty of Health Sciences, Curtin University , GPO Box U1987, Perth WA 6845,","place":["Australia"]},{"name":"Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council , Francie van Zijl Drive, Parowvallei, Cape Town 7500,","place":["South Africa"]},{"name":"Department of Psychiatry and Mental Health, University of Cape Town , Anzio Road, Observatory, Cape Town 7925,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9071-7958","authenticated-orcid":false,"given":"Susan","family":"Cleary","sequence":"additional","affiliation":[{"name":"Health Economics Unit, School of Public Health, University of Cape Town , Anzio Road, Observatory, Cape Town 7925,","place":["South Africa"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,8,3]]},"reference":[{"key":"2024101511391040600_R1","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-018-3772-8","article-title":"Cost-of-illness of type 2 diabetes mellitus in low and lower-middle-income countries: a systematic review","volume":"18","author":"Afroz","year":"2018","journal-title":"BMC Health Services Research"},{"key":"2024101511391040600_R2","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1373\/clinchem.2010.157586","article-title":"Point-of-Care Testing for Hb A(1c) in the management of diabetes: a systematic review and metaanalysis","volume":"57","author":"Al-Ansary","year":"2011","journal-title":"Clinical Chemistry"},{"key":"2024101511391040600_R3","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1007\/s40258-020-00618-0","article-title":"Health financing in Sub-Saharan Africa: from analytical frameworks to empirical 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