The Republic of Srpska (RS), as a part of the Western Balkans (WB) region, has a higher
diabetes prevalence than the EU. This study aims to assess the cost-effectiveness of early
treatment of high-risk patients with pre-diabetes and undiagnosed diabetes in our setting.
We designed a Markov chain Monte Carlo (MCMC) model which reflects the current
International Diabetes Federation (IDF) three-step plan for the prevention of T2DM in those
at increased risk. The model captures the evolution of the disease in FINDRISC high-risk
patients from normal glucose tolerance (NGT) to impaired fasting glucose (IFG) or impaired
glucose tolerance (IGT) and then to T2DM and its complications. We developed two MCMC
models, in order to follow the progression of the disease in high-risk cases, ie, when early
treatment is undertaken or when it is not undertaken. The health costs and quality adjusted
life years (QALY) were discounted at an annual rate of 3%. The key model parameters were
varied in one-way and probabilistic sensitivity analysis. Early treatment resulted in increased
life expectancy, postponement of the onset of diabetes and increased QALY for all patients.
The discounted incremental cost-effectiveness-ratios (ICER) in NGT, IFG, IGT, and T2DM
patients were −289.9, 9724.03, −1478.59 and 4084.67 €. In high-risk IGT patients, ICER was
the most favorable, being both a cost saving and QALY gaining, with the consistent results
confirmed by the sensitivity analysis. The results recommend the acceptance of a new health
policy of identifying IGT patients with the use of FINDRISC questionnaire and plasma glucose
measurements; providing them with a lifestyle change program; and implementing intensive
diabetes treatment, as their disease progresses. Our results are especially significant for the
Western Balkan countries, since this was the first cost-effectiveness study of T2DM prevention
in this region.
