Abstract
Type 2 diabetes mellitus (T2DM) is escalating rapidly across low- and middle-income countries, particularly in Vietnam where rural health infrastructure faces persistent shortages of specialized medical personnel. Task-shifting screening and early disease management to trained Village Health Workers (VHWs) offers a pragmatic solution, yet its long-term cost-effectiveness remains insufficiently quantified. We developed a Markov decision-analytic model to evaluate the cost-effectiveness of a community-based, task-shifting T2DM screening strategy compared with standard facility-based opportunistic care in rural Vietnam over a lifetime horizon. A hypothetical cohort of 10,000 adults aged 40 years and older was tracked through distinct health states: Undiagnosed T2DM, Diagnosed Uncomplicated T2DM, Microvascular Complications, Macrovascular Complications, and Death. Model parameters were parameterised using primary data from health facility surveys in Ha Nam province, published epidemiological literature, and regional clinical trials. From a societal perspective, the task-shifting screening strategy generated an average of 14.32 Quality-Adjusted Life Years (QALYs) per participant at a lifetime cost of $1,280 USD, compared to 13.91 QALYs and $1,110 USD for standard care. The incremental cost-effectiveness ratio (ICER) was $414.63 per QALY gained, placing it well below Vietnam's gross domestic product (GDP) per capita threshold ($4,300 USD). Sensitivity analyses confirmed the robustness of the model across parameter variations. Community-based task-shifting T2DM screening by VHWs is highly cost-effective in rural Vietnam and represents an actionable strategy for non-communicable disease control.
