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Estimating Cost-Effectiveness in Type 2 Diabetes
- Source :
- Medical Decision Making. 35:660-670
- Publication Year :
- 2015
- Publisher :
- SAGE Publications, 2015.
-
Abstract
- Objectives. Type 2 diabetes mellitus (T2DM) clinical guidelines focus on optimizing glucose control, with therapy escalation classically initiated within a “failure-based” regimen. Within many diabetes models, HbA1c therapy escalation thresholds play a pivotal role, controlling duration of therapy and, consequently, incremental costs and benefits. The objective of this study was to assess the relationship between therapy escalation threshold and time to therapy escalation on predicted cost-effectiveness of T2DM treatments. Methods. This study used the Cardiff Diabetes Model to illustrate the relationship between costs and health outcomes associated with first-, second-, and third-line therapy as a function of time on each. Data from routine clinical practice were used to contrast predicted costs and health outcomes associated with guideline therapy escalation thresholds compared with clinical practice. The impact of baseline HbA1c and therapy escalation thresholds on cost-effectiveness was investigated, comparing a sodium/glucose cotransporter 2 inhibitor v. sulfonylurea added to metformin monotherapy. Results. Lower thresholds are associated with a shorter time spent on monotherapy, ranging from 1.1 years (escalation at 6.5%) to 13 years (escalation at 9.0%) and an increase in total lifetime cost of therapy. Treatment-related disutility is minimized with higher thresholds because progression to insulin is delayed. Using metformin combined with either dapagliflozin or a sulfonylurea to illustrate lower baseline HbA1c and/or higher therapy escalation thresholds was associated with increased cost-effectiveness ratios, driven by a longer duration of therapy. Discussion. A marked difference in treatment cost-effectiveness was demonstrated when comparing routine clinical practice with guideline-advocated therapy escalation. This is important to both health care professionals and the wider health economic community with respect to understanding the true cost-effectiveness profile of any particular T2DM therapy option.
- Subjects :
- medicine.medical_specialty
Cost effectiveness
Cost-Benefit Analysis
Decision Making
Guidelines as Topic
Type 2 diabetes
Diabetes mellitus
Humans
Insulin
Medicine
Therapy duration
Intensive care medicine
Glycated Hemoglobin
business.industry
Health Policy
Type 2 Diabetes Mellitus
Health Care Costs
Guideline
Cost-effectiveness analysis
medicine.disease
Metformin
United Kingdom
Regimen
Models, Economic
Diabetes Mellitus, Type 2
Physical therapy
business
Subjects
Details
- ISSN :
- 1552681X and 0272989X
- Volume :
- 35
- Database :
- OpenAIRE
- Journal :
- Medical Decision Making
- Accession number :
- edsair.doi.dedup.....e763a50a135edb17e99a97a90fe33330