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International Journal of Public Health and Clinical Sciences (IJPHCS)
Open Access e-journal ISSN : 2289-7577


Saifulsyahira J., Salmiah M.S., Muhamad Hanafiah Juni



Background: Economic burden of diabetes was expected to continue to grow. In 2017, International Diabetes Federation (IDF) estimated the total healthcare expenditure was USD 727 billion (MYR 3260 billion) (20 – 79 years), which represented an 8% increase compared to 2015. A study had shown that up to 73% of diabetes-related healthcare costs result from hospitalization and ambulatory care, as a result of complications due to poor blood sugar control (IPH, 2015). Analysis by Shafei et al. (2012) showed that improved glycemic control would be likely to bring substantial clinical and economic benefits to the patients, arising primarily from reduced incidence of diabetes complications. HbA1c reduction was associated with reduced costs of treating diabetes complications and an increase in life expectancy. Health literacy intervention is one type of diabetic education approach which integrates self-efficacy and self-care behaviour into the module (Wolff et al., 2009). The aim of the intervention was to reduce the HbA1c by giving knowledge on how to manage their own diabetes.

Materials and Methods: The study design was randomized control trial with health economic evaluation for cost-effectiveness analysis. The intervention group received health literacy education module adapted from DLNET for the study, and control group received conventional health education module.    Cost effectiveness ratio (CER) and incremental cost effectiveness ratio (ICER) were calculated. The costs per unit of reducing HbA1c (%) was evaluated in both intervention and control groups, and decision rules were applied to determine cost effectiveness of intervention.

Result: Total cost at final cost centre for the intervention group was RM 68,113 while the total cost at final cost centre for the control group was RM 67,206. The intervention was cost effective with CER of 0.12 and ICER of RM 1,225 per HbA1c improvement.

Conclusion: The study revealed that health literacy education module intervention was cost effective in reducing HbA1c among type 2 diabetic patients at the study hospital.

Keywords: cost effectiveness, health literacy, education module interventionHbA1c, diabetes,

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