Table 4

Sensitivity and scenario analyses to assess the impact of the uncertainties around productivity, mortality and economic data inputs on productivity-adjusted life years (PALY) lost in those with diabetes in the Bangladeshi population and the associated economic impact

PALYs lost due to diabetes% change in PALYs lost compared with base caseGDP lost (US$ billion)GDP lost per person with diabetes (US$)
Base case9 273 21797.416 987
 Productivity indices upper uncertainty bound*8 773 791−5.492.316 098
 Productivity indices lower uncertainty bound*9 417 270+1.698.817 241
 Labour force dropout upper uncertainty bound†7 728 881−16.781.814 275
 Labour force dropout lower uncertainty bound†10 817 553+16.7112.919 699
 Upper uncertainty bound of all-cause mortality risk associated with diabetes‡11 159 921+20.5118.020 574
 Lower uncertainty bound of all-cause mortality risk associated with diabetes‡8 466 438−8.788.615 446
 Temporal trend in population mortality risk is doubled to a 2% reduction per year§9 158 579−1.296.116 759
 No temporal trend in population mortality risk§9 401 616+1.298.917 243
 Annual GDP growth rate is doubled to 3.6% per year¶112.919.692
 No temporal trend in GDP¶81.914 283
 Annual discount rate increased to 5%**7 691 123−17.179.013 780
 Annual discount rate reduced to 1.5%**10 875 985+17.3116.520 313
  • *Sensitivity analyses 1 and 2 apply (1) a 25% reduction and (2) a 25% increase in absenteeism estimate, holding all other model inputs constant.

  • †Sensitivity analyses 3 and 4 apply (3) a 25% reduction and (4) a 25% increase in diabetes-related labour force dropout estimates, holding all other model inputs constant.

  • ‡Sensitivity analyses 5 and 6 apply (5) the lower bound of the 95% CI and (6) the upper bound of the 95% CI around the estimate of relative risk of all-cause mortality associated with diabetes, holding all other model inputs constant.

  • §Scenario analyses 7 and 8 apply (7) double the annual reduction in mortality risk to 2% per year and (8) no temporal trend in population mortality risk, holding all other model inputs constant.

  • ¶Sensitivity analyses 9 and 10 apply (9) double the annual growth rate in GDP to 3.6% per year and (10) no temporal trend in GDP across the model, holding all other model inputs constant. These sensitivity analyses do not affect the number of PALYs lived but do affect their assumed value and therefore the resulting GDP lost.

  • **Sensitivity analyses 11 and 12 apply an annual discount rate (11) increased to 5% (in line with the WHO standard annual rate) and (12) reduced to 1.5%.

  • GDP, gross domestic product.