Cost-Effectiveness of the WHO Diabetes Compact Targets for Diabetes Control in India—A Microsimulation Modelling Study

Introduction and Objective: Diabetes affects over 100 million adults in India, but fewer than one in 10 are achieving optimal glycemic (HbA1c < 8.0%), blood pressure (BP; <140/90 mmHg), and LDL cholesterol (<100mg/dl or statin use) control. The WHO Diabetes Compact recommends target achievement for these metrics among people with diabetes to achieve broad population benefits. We estimated the health and economic impacts of achieving these targets for India to inform future health system planning. Methods: We developed a micro-simulation model to estimate the cost-effectiveness of attaining three Compact targets among those with diagnosed diabetes: 80% glycemic control, 80% BP control, and 60% statin use (for those >40 years). We simulated 20-year rates of complications (cardiovascular events, retinopathy, neuropathy, nephropathy) and mortality using data from the Longitudinal Aging Study in India (n = 9,678; 52.4% female). Clinical intervention effectiveness was based on national treatment guidelines and parameters from prior models. We evaluated health system costs in 2023 INT$ and INR₹, health status in disability adjusted life years (DALYs), and the incremental cost-effectiveness ratio (ICER) as cost per DALY averted. Results: Over 20 years achievement of three WHO Compact targets was associated with reductions of 22.8% in cases of retinopathy, 13.9% in nephropathy, 15.6% in foot ulcers, 26.1% in total myocardial infarctions, 30.0% in strokes, 28.0% in cardiovascular-related deaths. Total health system costs were lower in the optimal scenario, resulting in a mean cost savings of INT$630.20 (₹12,730.00) per patient, with an average 0.104 DALYs averted. Achieving these three Compact targets was cost saving, with an ICER of INT$-6059.60 (₹-122,403.85) per DALY averted. Conclusion: Attainment of WHO Diabetes Compact targets is expected to be cost saving for the Indian healthcare system and deliver improved health outcomes and reduced healthcare costs. Disclosure: E.L. Kocher: None. A.A. Abdeen: None. Y. Long: None. A. Baker: None. A. Sharma: None. T. Ayer: Consultant; GlaxoSmithKline plc, Gilead Sciences, Inc. J. Julien: None. M.K. Ali: Advisory Panel; Eli Lilly and Company. N. Tandon: None. J. Varghese: None. G. Garcia: None.