Evaluating the Cost-Effectiveness of the Praboromarajchanok Institute (PBRI) Model for Screening Hypertension and Diabetes in Singburi Province
1
Harvard T.H. Chan School of Public Health, Boston, United States
2
President's Office, Praboromarajchanok Institute, Ministry of Public Health, Bangkok, Thailand
3
Public Health, Provincial Office, Singburi, Ministry of Public Health, Singburi, Thailand
4
Harvard Medical School, Harvard University, Boston, United States
5
Sirindhorn College of Public Health, Trang, Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute, Trang, Thailand
Popul. Med. 2026;8(Supplement Supplement 1):A2927
ABSTRACT
INTRODUCTION:
Thailand faces a growing burden of non-communicable diseases, particularly hypertension and type 2 diabetes mellitus (T2DM), leading to substantial healthcare utilization and societal costs1. The Praboromarajchanok Institute (PBRI) 7-Color Model was implemented to support prevention-focused care2. This study evaluates risk distribution and the cost-effectiveness of the PBRI Model in screening for hypertension and T2DM in Singburi province from 2021 to 2024.
METHODS:
Repeated cross-sectional analyses used each patient’s most recent annual visit. Demographic and clinical characteristics were summarized by year. Risk profiles were classified using PBRI Model, with high-risk prevalence defined as patients in the Dark Green, Yellow, Orange, Red, or Black categories based on blood pressure and fasting blood sugar. Changes in risk category prevalence relative to 2021 were estimated using percentage-point differences with 95% bootstrap confidence intervals. Regression-adjusted cost-effectiveness analyses compared 2022–2024 with baseline (2021) among hospitals only, adjusting for age, sex, payment type, and hospital fixed effects. Analyses were conducted from societal and payer perspectives, with sensitivity analyses varying costs by ±20% and ±30%.
RESULTS:
Health center patients were older than hospital patients (mean 66–67 vs. 64–65 years) and had higher systolic blood pressure (low-to-mid 130s vs. 100–120 mmHg). Hypertension and T2DM accounted for 56–66% and about one-third of diagnoses, respectively. The Dark Green category was most prevalent in hospitals (50–59%). Relative to baseline, high-risk prevalence declined by nearly 6 percentage points by 2024. From the societal perspective, the PBRI Model was dominant, with societal costs decreasing by ~2,000 THB per percentage-point reduction in high-risk prevalence. From the payer perspective, direct medical costs increased modestly but remained cost-effective.
CONCLUSIONS:
The PBRI Model was associated with improved risk profiles and net societal cost savings in hospitals. The Ministry of Public Health may consider a phased rollout of prevention-focused risk stratification, prioritizing high-burden provinces before national implementation.
Thailand faces a growing burden of non-communicable diseases, particularly hypertension and type 2 diabetes mellitus (T2DM), leading to substantial healthcare utilization and societal costs1. The Praboromarajchanok Institute (PBRI) 7-Color Model was implemented to support prevention-focused care2. This study evaluates risk distribution and the cost-effectiveness of the PBRI Model in screening for hypertension and T2DM in Singburi province from 2021 to 2024.
METHODS:
Repeated cross-sectional analyses used each patient’s most recent annual visit. Demographic and clinical characteristics were summarized by year. Risk profiles were classified using PBRI Model, with high-risk prevalence defined as patients in the Dark Green, Yellow, Orange, Red, or Black categories based on blood pressure and fasting blood sugar. Changes in risk category prevalence relative to 2021 were estimated using percentage-point differences with 95% bootstrap confidence intervals. Regression-adjusted cost-effectiveness analyses compared 2022–2024 with baseline (2021) among hospitals only, adjusting for age, sex, payment type, and hospital fixed effects. Analyses were conducted from societal and payer perspectives, with sensitivity analyses varying costs by ±20% and ±30%.
RESULTS:
Health center patients were older than hospital patients (mean 66–67 vs. 64–65 years) and had higher systolic blood pressure (low-to-mid 130s vs. 100–120 mmHg). Hypertension and T2DM accounted for 56–66% and about one-third of diagnoses, respectively. The Dark Green category was most prevalent in hospitals (50–59%). Relative to baseline, high-risk prevalence declined by nearly 6 percentage points by 2024. From the societal perspective, the PBRI Model was dominant, with societal costs decreasing by ~2,000 THB per percentage-point reduction in high-risk prevalence. From the payer perspective, direct medical costs increased modestly but remained cost-effective.
CONCLUSIONS:
The PBRI Model was associated with improved risk profiles and net societal cost savings in hospitals. The Ministry of Public Health may consider a phased rollout of prevention-focused risk stratification, prioritizing high-burden provinces before national implementation.
| eISSN: | 2654-1459 |
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