{
  "abstract": "Introduction Using the community-based participatory research (CBPR) methodology, sustained peer group treatment has effectively improved medication adherence. Although many studies investigate the effectiveness of peer group therapy, there is a lack of evidence addressing the cost-effectiveness of CBPR models in low- and middle-income countries. This protocol outlines the methods for the economic evaluation of the PArticipatory Research model for medicaTIon adherenCe In People with diAbetes and hyperTEnsion (PARTICIPATE) trial to determine whether the CBPR approach to enhance medication adherence among patients with diabetes and/or hypertension is cost-effective in India.Methods and analysis A within-trial cost-effectiveness analysis (CEA) from a societal perspective will be conducted alongside a multicentre cluster randomised controlled trial to identify, measure and evaluate the key resource and outcome impacts of a CBPR model compared with usual care aimed at improving medication adherence in adult rural Indian patients with diabetes and/or hypertension. The CEA will provide results in terms of the cost per improvement in medication adherence score, and a cost-utility analysis (CUA) will express the findings as the cost per disability-adjusted life year (DALY) or quality-adjusted life year (QALY) gained. Intervention costs and effects will be projected for the population of Indian adults with diabetes and/or hypertension who are on medication, analysed over the cohort’s lifetime. Results from the modelled CUA will detail incremental costs, costs per death averted and costs per DALY averted/QALY gained for the interventions relative to the comparator. Incremental cost-effectiveness ratios will be computed by dividing the cost difference between the intervention and comparator by the difference in benefits. Health economic evaluation methods, including a lifetime horizon, a 3% discount rate for costs and benefits and a societal perspective, will be followed. The effects of sampling uncertainty on estimated incremental costs and effectiveness parameters, as well as the influence of methodological assumptions (such as the discount rate and study perspective), will be examined through both deterministic and probabilistic sensitivity analyses. Relevant differences in costs, outcomes or cost-effectiveness disparities among subgroups of patients with varying baseline characteristics will also be reported. Results will be illustrated using cost-effectiveness acceptability curves across a range of willingness-to-pay thresholds. Modelled CUA will broaden the target population and time frame to offer decision-makers insights into the cost-effectiveness of the CBPR approach for enhancing medication adherence. Furthermore, a return on investment analysis will be performed to express benefits in monetary terms relative to investments made, allowing for a comprehensive expression of both costs and the full spectrum of intervention benefits in monetary units.Ethics and dissemination The Institutional Ethics Committee of Sri Aurobindo Medical College and PGI, Indore, provided ethics approval. The results of the main trial and economic evaluation will be submitted for publication in a peer-reviewed journal and disseminated through reports to Indian Council of Medical Research and conference presentations.Trial registration number Clinical Trial Registry of India (CTRI) CTRI/2024/01/061939.",
  "authors": [
    {
      "affiliations": [
        "Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bangalore, Karnataka, India",
        "School of Public Health, University of Adelaide, South Australia, Australia"
      ],
      "name": "Denny John"
    },
    {
      "affiliations": [
        "Department of Pharmacology, Sri Aurobindo Medical College and Postgraduate Institute, Indore, Madhya Pradesh, India"
      ],
      "name": "Pooja Reddy"
    },
    {
      "affiliations": [
        "Department of Pharmacology, Sri Aurobindo Medical College and Postgraduate Institute, Indore, Madhya Pradesh, India"
      ],
      "name": "Anuja Jha"
    },
    {
      "affiliations": [
        "Department of Community Medicine, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India"
      ],
      "name": "Harshal Gupta"
    },
    {
      "affiliations": [
        "Department of Statisitics, Assam University, Cachar, Assam, India"
      ],
      "name": "Vivek Verma"
    },
    {
      "affiliations": [
        "Department of Community Medicine, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India"
      ],
      "name": "Dinesh Kumar"
    },
    {
      "affiliations": [
        "National JALMA Institute of Leprosy and other Mycobacterial Diseases, Agra, Uttar Pradesh, India"
      ],
      "name": "Avi Kumar Bansal"
    },
    {
      "affiliations": [
        "Department of Transfusion Medicine, SCB Medical College and Hospital, Cuttack, Orissa, India"
      ],
      "name": "Smita Mahapatra"
    },
    {
      "affiliations": [
        "ICMR, Regional Medical Research Centre, Bhubaneswar, Orissa, India"
      ],
      "name": "Tanveer Rehman"
    },
    {
      "affiliations": [
        "Department of Community Medicine, SCB Medical College and Hospital, Cuttack, Orissa, India"
      ],
      "name": "Sudhira Kumar Parida"
    },
    {
      "affiliations": [
        "MRU, SCB Medical College and Hospital, Cuttack, Orissa, India"
      ],
      "name": "Mamata Jena"
    },
    {
      "affiliations": [
        "Community Medicine, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India"
      ],
      "name": "A Charles Pon Ruban"
    },
    {
      "affiliations": [
        "Pathology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India"
      ],
      "name": "Shantaraman Kalyanaraman"
    },
    {
      "affiliations": [
        "Community Medicine, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India"
      ],
      "name": "K Sunitha"
    },
    {
      "affiliations": [
        "Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden",
        "Clinical Studies and Trials Unit, Division of Development Research, Indian Council of Medical Research, Ministry of Health and Family Welfare, New Delhi, India",
        "Faculty of Medical Research, Academy of Scientific and Innovative Research, Ghaziabad, India"
      ],
      "name": "Jerin Jose Cherian"
    },
    {
      "affiliations": [
        "Clinical Studies and Trials Unit, Division of Development Research, Indian Council of Medical Research, Ministry of Health and Family Welfare, New Delhi, India"
      ],
      "name": "Tanu Anand"
    }
  ],
  "title": "Protocol for the economic evaluation alongside the PARTICIPATE (PArticipatory Research model for medicaTIon adherenCe In People with diAbetes and hyperTEnsion) multicenter cluster randomized trial",
  "uid": "cd74d9b0-0760-543e-a661-7323e1fe4959"
}