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Wang Y, Xu Y, Shan H, Pan H, Chen J, Yang J. Health state utility values of type 2 diabetes mellitus and related complications: a systematic review and meta-regression. Health Qual Life Outcomes 2024; 22:74. [PMID: 39244536 PMCID: PMC11380328 DOI: 10.1186/s12955-024-02288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/26/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND This study aimed to synthesize and quantitatively examine Health State Utility Values (HSUVs) for Type 2 Diabetes Mellitus (T2DM) and its complications, providing a robust meta-regression framework for selecting appropriate HSUV estimates. METHOD We conducted a systematic review to extract HSUVs for T2DM and its complications, encompassing various influencing factors. Relevant literature was sourced from a review spanning 2000-2020, supplemented by literature from PubMed, Embase, and the Web of Science (up to March 2024). Multivariate meta-regression was performed to evaluate the impact of measurement tools, tariffs, health status, and clinical and demographic variables on HSUVs. RESULTS Our search yielded 118 studies, contributing 1044 HSUVs. The HSUVs for T2DM with complications varied, from 0.65 for cerebrovascular disease to 0.77 for neuropathy. The EQ-5D-3L emerged as the most frequently employed valuation method. HSUV differences across instruments were observed; 15-D had the highest (0.89), while HUI-3 had the lowest (0.70) values. Regression analysis elucidated the significant effects of instrument and tariff choice on HSUVs. Complication-related utility decrement, especially in diabetic foot, was quantified. Age <70 was linked to increased HSUVs, while longer illness duration, hypertension, overweight and obesity correlated with reduced HSUVs. CONCLUSION Accurate HSUVs are vital for the optimization of T2DM management strategies. This study provided a comprehensive data pool for HSUVs selection, and quantified the influence of various factors on HSUVs, informing analysts and policymakers in understanding the utility variations associated with T2DM and its complications.
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Affiliation(s)
- Yubo Wang
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Yueru Xu
- School of Pharmacy, Xinjiang Medical University, No.393 XinYi Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Huiting Shan
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Huimin Pan
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Ji Chen
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China.
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China.
| | - Jianhua Yang
- Department of Pharmacy, 1/F, Science and Technology Building, The First Affiliated Hospital of Xinjiang Medical University, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China.
- Xinjiang Key Laboratory of Clinical Drug Research, No.137 Liyushan Road, Xinshi District, Urumqi, Xinjiang Uygur Autonomous Region, China.
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Fidan C, Ağırbaş İ. The health-related quality of life of patients with type 1 and type 2 diabetes mellitus: a meta-analysis. Endocrine 2024; 85:1170-1177. [PMID: 38632164 DOI: 10.1007/s12020-024-03824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/06/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE We need to know about the health-related quality of life (HRQoL) of patients with diabetes mellitus (DM) to assess their health outcomes. Quantitative studies have discussed whether patients with Type 1 DM (T1DM) have better HRQoL than those with Type 2 DM (T2DM) or vice versa. However, no meta-analyses have addressed the HRQoL of patients with T1DM and T2DM together. Therefore, the primary objective of this meta-analysis was to investigate the HRQoL of patients with T1DM and T2DM. The secondary objective of this meta-analysis was to use various scales to assess the HRQoL of patients with T1DM and T2DM. METHODS The inclusion criteria were (1) study participants were diagnosed with T1DM and T2DM and were aged 18 years or older, (2) outcome measure was HRQoL as assessed by appropriate instruments, (3) study written in the English language, (4) research articles using quantitative research methods, (5) study with full-text access, and (6) study reporting the necessary statistics to calculate the effect size. Cohen's d was used to calculate effect sizes, while the random effect model was used to calculate the joint effect size. RESULTS The sample consisted of seven articles, which recruited a total of 4.896 patients with DM. Patients with T1DM and T2DM had similar HRQoL. According to the EQ-5D-5L, patients with T1DM had a higher HRQoL than those with T2DM. According to the EQ-5D-VAS and SF-36, patients with T1DM and T2DM had similar HRQoL. The Egger's regression analysis indicated no publication bias. CONCLUSION Our results are sample-specific and cannot be generalized to all patients with DM. Therefore, more research is warranted on this topic.
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Affiliation(s)
- Cuma Fidan
- Department of Healthcare Management, Muş Alparslan University, Muş, Turkey.
| | - İsmail Ağırbaş
- Department of Healthcare Management, Ankara University, Ankara, Turkey
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Tan MHP, Ong SC, Tahir NAM, Ali AM, Mustafa N. Health state utility values ranges across varying stages and severity of type 2 diabetes-related complications: A systematic review. PLoS One 2024; 19:e0297589. [PMID: 38574169 PMCID: PMC10994347 DOI: 10.1371/journal.pone.0297589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/09/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Health state utility values (HSUV) for Type 2 diabetes mellitus (T2DM) complications are useful in economic evaluations to determine cost effectiveness of an intervention. However, there is a lack of reference ranges for different severity and stages of individual complications. This study aimed to provide an overview of HSUV decrement ranges for common T2DM complications focusing on different severity and stages of complications. METHOD A systematic search was conducted in MEDLINE, SCOPUS, WEB OF SCIENCE. (Jan 2000 to April 2022). Included studies for HSUV estimates were from outpatient setting, regardless of treatment types, complication stages, regions and HRQoL instruments. Health Related Quality of Life (HRQoL) outcomes was to be presented as HSUV decrement values, adjusted according to social demographics and comorbidities. Adjusted HSUV decrements were extracted and compiled according to individual complications. After which, subsequently grouped into mild or severe category for comparison. RESULTS Searches identified 35 studies. The size of the study population ranged from 160 to 14,826. The HSUV decrement range was widest for cerebrovascular disease (stroke): -0.0060 to -0.0780 for mild stroke and -0.035 to -0.266 for severe stroke; retinopathy: mild (-0.005 to -0.0862), moderate (-0.0030 to -0.1845) and severe retinopathy (-0.023 to -0.2434); amputation: (-0.1050 to -0.2880). Different nature of complication severity defined in studies could be categorized into: those with acute nature, chronic with lasting effects, those with symptoms at early stage or those with repetitive frequency or episodes. DISCUSSION Overview of HSUV decrement ranges across different stages of each T2DM diabetes-related complications shows that chronic complications with lasting impact such as amputation, severe stroke with sequelae and severe retinopathy with blindness were generally associated with larger HSUV decrement range. Considerable heterogeneities exist across the studies. Promoting standardized complication definitions and identifying the most influential health state stages on HSUV decrements may assist researchers for future cost-effectiveness studies.
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Affiliation(s)
- Michelle Hwee Pheng Tan
- Pharmacy Department, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Nurul Ain Mohd Tahir
- Department of Pharmacy, Kampus Kuala Lumpur Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- Department of Pharmacy, Kampus Kuala Lumpur Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norlaila Mustafa
- Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Morrow LM, Becker F, Coleman RL, Gerstein HC, Rydén L, Schöder S, Gray AM, Leal J, Holman RR. Comparison of medical resources and costs among patients with coronary heart disease and impaired glucose tolerance in the Acarbose Cardiovascular Evaluation trial. J Diabetes 2024; 16:e13473. [PMID: 37915263 PMCID: PMC10859317 DOI: 10.1111/1753-0407.13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 07/26/2023] [Accepted: 08/19/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The Acarbose Cardiovascular Evaluation (ACE) trial (ISRCTN91899513) evaluated the alpha-glucosidase inhibitor acarbose, compared with placebo, in 6522 patients with coronary heart disease and impaired glucose tolerance in China and showed a reduced incidence of diabetes. We assessed the within-trial medical resource use and costs, and quality-adjusted life years (QALYs). METHODS Resource use data were collected prospectively within the ACE trial. Hospitalizations, medications, and outpatient visits were valued using Chinese unit costs. Medication use was measured in drug days, with cardiovascular and diabetes drugs summed across the trial by participant. Health-related quality of life was captured using the EuroQol-5 Dimension-3 Level questionnaire. Regression analyses were used to compare resource use, costs, and QALYs, accounting for regional variation. Costs and QALYs were discounted at 3% yearly. RESULTS Hospitalizations were 6% higher in the acarbose arm during the trial (rate ratio 1.06, p = .009), but there were no significant differences in total inpatient days (rate ratio 1.04, p = .30). Total costs per participant, including study drug, were significantly higher for acarbose (¥ [Yuan] 56 480, £6213), compared with placebo (¥48 079, £5289; mean ratio 1.18, p < 0.001). QALYs reported by participants in the acarbose arm (3.96 QALYs) were marginally higher than in the placebo arm (3.95 QALYs), but the difference was not statistically significant (0.01 QALYs; p = .58). CONCLUSIONS Acarbose, compared with placebo, participants cost more due to study drug costs and reported no statistically significant difference in QALYs. These higher within-trial costs could potentially be offset in future by savings from the acarbose-related lower incidence of diabetes.
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Affiliation(s)
- Liam Mc Morrow
- Health Economics Research CentreUniversity of OxfordOxfordUK
| | - Frauke Becker
- Health Economics Research CentreUniversity of OxfordOxfordUK
| | - Ruth L. Coleman
- Diabetes Trials Unit, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Hertzel C. Gerstein
- Department of Medicine and Population Health Research InstituteMcMaster University and Hamilton Health SciencesHamiltonCanada
| | - Lars Rydén
- Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | | | | | - Jose Leal
- Health Economics Research CentreUniversity of OxfordOxfordUK
| | - Rury R. Holman
- Diabetes Trials Unit, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
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Niño-de-Guzmán E, Bracchiglione J, Vásquez-Mejía A, de Graaf G, Rocha Calderón C, Alonso-Coello P. How Do Patients With Type 2 Diabetes Mellitus Value the Importance of Outcomes? An Overview of Reviews. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1782-1794. [PMID: 37516195 DOI: 10.1016/j.jval.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/16/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES We aimed to assess how patients value the importance of type 2 diabetes mellitus (T2DM) related outcomes. METHODS Overview of systematic reviews (SRs) reporting patients' utilities or disutilities for T2DM outcomes. We searched 3 databases from inception until June 2021. Study selection and data extraction were conducted in pairs. We evaluated the quality of SRs with the Joanna Briggs Institute Checklist, and the overlap with the corrected covered area. We estimated descriptive statistics, and, when possible, conducted metanalysis. RESULTS We identified 11 SRs, including 119 studies and 70 outcomes. Most reviews were high-quality SRs. The outcomes with the lowest utilities were hypoglycemia with very severe symptoms (acute complications), stroke (macrovascular complications), diabetic peripheral neuropathy with severe pain (microvascular complications), extreme obesity (comorbidities), and insulin only or combined (management of diabetes). Good/excellent glucose control and noninsulin injectable showed higher values than T2DM without complications. The outcomes with the highest disutilities were amputation, depression, major hypoglycemia, stroke, and management using only insulin. CONCLUSIONS We provide standardized, reliable utility values (or associated disutilities) for T2DM, acute, microvascular and macrovascular complications, related comorbidities and treatments that may support judgments when making clinical recommendations, designing decision support tools, and developing interventions and economic analysis.
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Affiliation(s)
- Ena Niño-de-Guzmán
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Cancer Prevention and Control Programme, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Javier Bracchiglione
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Valparaíso, Chile; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Adrián Vásquez-Mejía
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Gimon de Graaf
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Claudio Rocha Calderón
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Prabowo MH, Febrinasari RP, Pamungkasari EP, Mahendradhata Y, Pulkki-Brännström AM, Probandari A. Health-related Quality of Life of Patients With Diabetes Mellitus Measured With the Bahasa Indonesia Version of EQ-5D in Primary Care Settings in Indonesia. J Prev Med Public Health 2023; 56:467-474. [PMID: 37828874 PMCID: PMC10579634 DOI: 10.3961/jpmph.23.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES Diabetes mellitus (DM) is a serious public health issue that places a heavy financial, social, and health-related burden on individuals, families, and healthcare systems. Self-reported health-related quality of life (HRQoL) is extensively used for monitoring the general population's health conditions and measuring the effectiveness of interventions. Therefore, this study investigated HRQoL and associated factors among patients with type 2 DM at a primary healthcare center in Indonesia. METHODS A cross-sectional study was conducted in Klaten District, Central Java, Indonesia, from May 2019 to July 2019. In total, 260 patients with DM registered with National Health Insurance were interviewed. HRQoL was measured with the EuroQol Group's validated Bahasa Indonesia version of the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) with the Indonesian value set. Multivariate regression models were used to identify factors influencing HRQoL. RESULTS Data from 24 patients were excluded due to incomplete information. Most participants were men (60.6%), were aged above 50 years (91.5%), had less than a senior high school education (75.0%), and were unemployed (85.6%). The most frequent health problems were reported for the pain/discomfort dimension (64.0%) followed by anxiety (28.4%), mobility (17.8%), usual activities (10.6%), and self-care (6.8%). The average EuroQoL 5-Dimension (EQ-5D) index score was 0.86 (95% confidence interval [CI], 0.83 to 0.88). In the multivariate ordinal regression model, a higher education level (coefficient, 0.08; 95% CI, 0.02 to 0.14) was a significant predictor of the EQ-5D-5L utility score. CONCLUSIONS Patients with diabetes had poorer EQ-5D-5L utility values than the general population. DM patients experienced pain/discomfort and anxiety. There was a substantial positive relationship between education level and HRQoL.
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Affiliation(s)
- Muhammad Husen Prabowo
- Doctoral Program of Public Health, School of Graduate, Universitas Sebelas Maret, Surakarta, Indonesia
| | | | | | - Yodi Mahendradhata
- Department of Health Policy and Management, Faculty of Medicine, Nursing and Public Health, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
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Fan M, Stephan AJ, Emmert-Fees K, Peters A, Laxy M. Health and economic impact of improved glucose, blood pressure and lipid control among German adults with type 2 diabetes: a modelling study. Diabetologia 2023; 66:1693-1704. [PMID: 37391625 PMCID: PMC10390361 DOI: 10.1007/s00125-023-05950-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/18/2023] [Indexed: 07/02/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to estimate the long-term health and economic consequences of improved risk factor control in German adults with type 2 diabetes. METHODS We used the UK Prospective Diabetes Study Outcomes Model 2 to project the patient-level health outcomes and healthcare costs of people with type 2 diabetes in Germany over 5, 10 and 30 years. We parameterised the model using the best available data on population characteristics, healthcare costs and health-related quality of life from German studies. The modelled scenarios were: (1) a permanent reduction of HbA1c by 5.5 mmol/mol (0.5%), of systolic BP (SBP) by 10 mmHg, or of LDL-cholesterol by 0.26 mmol/l in all patients, and (2) achievement of guideline care recommendations for HbA1c (≤53 mmol/mol [7%]), SBP (≤140 mmHg) or LDL-cholesterol (≤2.6 mmol/l) in patients who do not meet the recommendations. We calculated nationwide estimates using age- and sex-specific quality-adjusted life year (QALY) and cost estimates, type 2 diabetes prevalence and population size. RESULTS Over 10 years, a permanent reduction of HbA1c by 5.5 mmol/mol (0.5%), SBP by 10 mmHg or LDL-cholesterol by 0.26 mmol/l led to per-person savings in healthcare expenditures of €121, €238 and €34, and 0.01, 0.02 and 0.015 QALYs gained, respectively. Achieving guideline care recommendations for HbA1c, SBP or LDL-cholesterol could reduce healthcare expenditure by €451, €507 and €327 and gained 0.03, 0.05 and 0.06 additional QALYs in individuals who did not meet the recommendations. Nationally, achieving guideline care recommendations for HbA1c, SBP and LDL-cholesterol could reduce healthcare costs by over €1.9 billion. CONCLUSIONS/INTERPRETATION Sustained improvements in HbA1c, SBP and LDL-cholesterol control among diabetes patients in Germany can lead to substantial health benefits and reduce healthcare expenditures.
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Affiliation(s)
- Min Fan
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.
- German Center for Diabetes Research (DZD), Munich, Germany.
- Institute of Health Economics and Health Care Management, Helmholtz Munich, Munich, Germany.
| | - Anna-Janina Stephan
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Munich, Munich, Germany
| | - Karl Emmert-Fees
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Munich, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Munich, Munich, Germany
| | - Michael Laxy
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Munich, Munich, Germany
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Moffatt S, Wildman J, Pollard TM, Gibson K, Wildman JM, O’Brien N, Griffith B, Morris SL, Moloney E, Jeffries J, Pearce M, Mohammed W. Impact of a social prescribing intervention in North East England on adults with type 2 diabetes: the SPRING_NE multimethod study. PUBLIC HEALTH RESEARCH 2023; 11:1-185. [DOI: 10.3310/aqxc8219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Background
Link worker social prescribing enables health-care professionals to address patients’ non-medical needs by linking patients into various services. Evidence for its effectiveness and how it is experienced by link workers and clients is lacking.
Objectives
To evaluate the impact and costs of a link worker social prescribing intervention on health and health-care costs and utilisation and to observe link worker delivery and patient engagement.
Data sources
Quality Outcomes Framework and Secondary Services Use data.
Design
Multimethods comprising (1) quasi-experimental evaluation of effects of social prescribing on health and health-care use, (2) cost-effectiveness analysis, (3) ethnographic methods to explore intervention delivery and receipt, and (4) a supplementary interview study examining intervention impact during the first UK COVID-19 lockdown (April–July 2020).
Study population and setting
Community-dwelling adults aged 40–74 years with type 2 diabetes and link workers in a socioeconomically deprived locality of North East England, UK.
Intervention
Link worker social prescribing to improve health and well-being-related outcomes among people with long-term conditions.
Participants
(1) Health outcomes study, approximately n = 8400 patients; EuroQol-5 Dimensions, five-level version (EQ-5D-5L), study, n = 694 (baseline) and n = 474 (follow-up); (2) ethnography, n = 20 link workers and n = 19 clients; and COVID-19 interviews, n = 14 staff and n = 44 clients.
Main outcome measures
The main outcome measures were glycated haemoglobin level (HbA1c; primary outcome), body mass index, blood pressure, cholesterol level, smoking status, health-care costs and utilisation, and EQ-5D-5L score.
Results
Intention-to-treat analysis of approximately 8400 patients in 13 intervention and 11 control general practices demonstrated a statistically significant, although not clinically significant, difference in HbA1c level (–1.11 mmol/mol) and a non-statistically significant 1.5-percentage-point reduction in the probability of having high blood pressure, but no statistically significant effects on other outcomes. Health-care cost estimates ranged from £18.22 (individuals with one extra comorbidity) to –£50.35 (individuals with no extra comorbidity). A statistically non-significant shift from unplanned (non-elective and accident and emergency admissions) to planned care (elective and outpatient care) was observed. Subgroup analysis showed more benefit for individuals living in more deprived areas, for the ethnically white and those with fewer comorbidities. The mean cost of the intervention itself was £1345 per participant; the incremental mean health gain was 0.004 quality-adjusted life-years (95% confidence interval –0.022 to 0.029 quality-adjusted life-years); and the incremental cost-effectiveness ratio was £327,250 per quality-adjusted life-year gained. Ethnographic data showed that successfully embedded, holistic social prescribing providing supported linking to navigate social determinants of health was challenging to deliver, but could offer opportunities for improving health and well-being. However, the intervention was heterogeneous and was shaped in unanticipated ways by the delivery context. Pressures to generate referrals and meet targets detracted from face-to-face contact and capacity to address setbacks among those with complex health and social problems.
Limitations
The limitations of the study include (1) a reduced sample size because of non-participation of seven general practices; (2) incompleteness and unreliability of some of the Quality and Outcomes Framework data; (3) unavailability of accurate data on intervention intensity and patient comorbidity; (4) reliance on an exploratory analysis with significant sensitivity analysis; and (5) limited perspectives from voluntary, community and social enterprise.
Conclusions
This social prescribing model resulted in a small improvement in glycaemic control. Outcome effects varied across different groups and the experience of social prescribing differed depending on client circumstances.
Future work
To examine how the NHS Primary Care Network social prescribing is being operationalised; its impact on health outcomes, service use and costs; and its tailoring to different contexts.
Trial registration
This trial is registered as ISRCTN13880272.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme, Community Groups and Health Promotion (grant no. 16/122/33) and will be published in full in Public Health Research; Vol. 11, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Suzanne Moffatt
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Kate Gibson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Josephine M Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola O’Brien
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Bethan Griffith
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Eoin Moloney
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jayne Jeffries
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Pearce
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Wael Mohammed
- Public Health Economics and Decision Science (DTC), Sheffield University, Sheffield, UK
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Tew M, Willis M, Asseburg C, Bennett H, Brennan A, Feenstra T, Gahn J, Gray A, Heathcote L, Herman WH, Isaman D, Kuo S, Lamotte M, Leal J, McEwan P, Nilsson A, Palmer AJ, Patel R, Pollard D, Ramos M, Sailer F, Schramm W, Shao H, Shi L, Si L, Smolen HJ, Thomas C, Tran-Duy A, Yang C, Ye W, Yu X, Zhang P, Clarke P. Exploring Structural Uncertainty and Impact of Health State Utility Values on Lifetime Outcomes in Diabetes Economic Simulation Models: Findings from the Ninth Mount Hood Diabetes Quality-of-Life Challenge. Med Decis Making 2022; 42:599-611. [PMID: 34911405 PMCID: PMC9329757 DOI: 10.1177/0272989x211065479] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Structural uncertainty can affect model-based economic simulation estimates and study conclusions. Unfortunately, unlike parameter uncertainty, relatively little is known about its magnitude of impact on life-years (LYs) and quality-adjusted life-years (QALYs) in modeling of diabetes. We leveraged the Mount Hood Diabetes Challenge Network, a biennial conference attended by international diabetes modeling groups, to assess structural uncertainty in simulating QALYs in type 2 diabetes simulation models. METHODS Eleven type 2 diabetes simulation modeling groups participated in the 9th Mount Hood Diabetes Challenge. Modeling groups simulated 5 diabetes-related intervention profiles using predefined baseline characteristics and a standard utility value set for diabetes-related complications. LYs and QALYs were reported. Simulations were repeated using lower and upper limits of the 95% confidence intervals of utility inputs. Changes in LYs and QALYs from tested interventions were compared across models. Additional analyses were conducted postchallenge to investigate drivers of cross-model differences. RESULTS Substantial cross-model variability in incremental LYs and QALYs was observed, particularly for HbA1c and body mass index (BMI) intervention profiles. For a 0.5%-point permanent HbA1c reduction, LY gains ranged from 0.050 to 0.750. For a 1-unit permanent BMI reduction, incremental QALYs varied from a small decrease in QALYs (-0.024) to an increase of 0.203. Changes in utility values of health states had a much smaller impact (to the hundredth of a decimal place) on incremental QALYs. Microsimulation models were found to generate a mean of 3.41 more LYs than cohort simulation models (P = 0.049). CONCLUSIONS Variations in utility values contribute to a lesser extent than uncertainty captured as structural uncertainty. These findings reinforce the importance of assessing structural uncertainty thoroughly because the choice of model (or models) can influence study results, which can serve as evidence for resource allocation decisions.HighlightsThe findings indicate substantial cross-model variability in QALY predictions for a standardized set of simulation scenarios and is considerably larger than within model variability to alternative health state utility values (e.g., lower and upper limits of the 95% confidence intervals of utility inputs).There is a need to understand and assess structural uncertainty, as the choice of model to inform resource allocation decisions can matter more than the choice of health state utility values.
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Affiliation(s)
- Michelle Tew
- Centre for Health Policy, Melbourne School of
Population and Global Health, The University of Melbourne, Melbourne,
Victoria, Australia
| | - Michael Willis
- The Swedish Institute for Health Economics,
Lund, Sweden
| | | | | | - Alan Brennan
- School of Health and Related Research,
University of Sheffield, Sheffield, UK
| | - Talitha Feenstra
- Groningen University, Faculty of Science and
Engineering, GRIP, Groningen, The Netherlands,Groningen University, UMCG, Groningen, The
Netherlands,Netherlands Institute for Public Health and the
Environment (RIVM), Bilthoven, The Netherlands
| | - James Gahn
- Medical Decision Modeling Inc., Indianapolis,
IN, USA
| | - Alastair Gray
- Health Economics Research Centre, Nuffield
Department of Population Health, University of Oxford, Oxford, UK
| | - Laura Heathcote
- School of Health and Related Research,
University of Sheffield, Sheffield, UK
| | - William H. Herman
- Department of Internal Medicine, University of
Michigan, Ann Arbor, MI, USA
| | - Deanna Isaman
- Department of Biostatistics, University of
Michigan, Ann Arbor, MI, USA
| | - Shihchen Kuo
- Department of Internal Medicine, University of
Michigan, Ann Arbor, MI, USA
| | - Mark Lamotte
- Global Health Economics and Outcomes Research,
Real World Solutions, IQVIA, Zaventem, Belgium
| | - José Leal
- Health Economics Research Centre, Nuffield
Department of Population Health, University of Oxford, Oxford, UK
| | - Phil McEwan
- Health Economics and Outcomes Research Ltd,
Cardiff, UK
| | | | - Andrew J. Palmer
- Centre for Health Policy, Melbourne School of
Population and Global Health, The University of Melbourne, Melbourne,
Victoria, Australia,Menzies Institute for Medical Research, The
University of Tasmania, Hobart, Tasmania, Australia
| | - Rishi Patel
- Health Economics Research Centre, Nuffield
Department of Population Health, University of Oxford, Oxford, UK
| | - Daniel Pollard
- School of Health and Related Research,
University of Sheffield, Sheffield, UK
| | - Mafalda Ramos
- Global Health Economics and Outcomes Research,
Real World Solutions, IQVIA, Porto Salvo, Portugal
| | - Fabian Sailer
- GECKO Institute for Medicine, Informatics and
Economics, Heilbronn University, Heilbronn, Germany
| | - Wendelin Schramm
- GECKO Institute for Medicine, Informatics and
Economics, Heilbronn University, Heilbronn, Germany
| | - Hui Shao
- Department of Pharmaceutical Outcomes and
Policy. University of Florida College of Pharmacy. Gainesville, FL,
USA
| | - Lizheng Shi
- Department of Health Policy and Management;
Tulane University School of Public Health and Tropical Medicine
| | - Lei Si
- Menzies Institute for Medical Research, The
University of Tasmania, Hobart, Tasmania, Australia,The George Institute for Global Health, UNSW
Sydney, Kensington, Australia
| | | | - Chloe Thomas
- School of Health and Related Research,
University of Sheffield, Sheffield, UK
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of
Population and Global Health, The University of Melbourne, Melbourne,
Victoria, Australia
| | - Chunting Yang
- Department of Biostatistics, University of
Michigan, Ann Arbor, MI, USA
| | - Wen Ye
- Department of Biostatistics, University of
Michigan, Ann Arbor, MI, USA
| | - Xueting Yu
- Medical Decision Modeling Inc., Indianapolis,
IN, USA
| | - Ping Zhang
- Division of Diabetes Translation, Centres for
Disease Control and Prevention, Atlanta, GA, USA
| | - Philip Clarke
- Philip Clarke, Health Economics Research
Centre, Nuffield Department of Population Health, University of Oxford, Oxford,
UK; ()
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10
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Leal J, Becker F, Lim L, Holman RR, Gray AM. Health utilities in Chinese patients with coronary heart disease and impaired glucose tolerance (ACE): A longitudinal analysis of a randomized, double-blind, placebo-controlled trial. J Diabetes 2022; 14:455-464. [PMID: 35876124 PMCID: PMC9310045 DOI: 10.1111/1753-0407.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We estimate health-related quality of life and the impact of four cardiovascular events (myocardial infarction [MI], stroke, congestive heart failure, angina) and gastrointestinal events in 6522 Chinese patients with coronary heart disease (CHD) and impaired glucose tolerance (IGT) participating in the Acarbose Cardiovascular Evaluation (ACE) trial. METHODS Health-related quality of life was captured using the EuroQol-5 Dimension-3 Level (EQ-5D-3L), with data collected at baseline and throughout the trial. Multilevel mixed-effects linear regression with random effects estimated health-related quality of life over time, capturing variation between hospital sites and individuals, and a fixed-effects linear model estimated the impact of cardiovascular and gastrointestinal events. RESULTS Patients were followed for a median of 5 years (interquartile range 3.4-6.0). The average baseline EQ-5D score of 0.930 (SD 0.104) remained relatively unchanged over the trial period with no evidence of statistically significant differences in EQ-5D score between randomized treatment groups. The largest decrement in the year of an event was estimated for stroke (-0.107, P < .001), followed by heart failure (-0.039, P = .022), MI (-0.021, P = .047), angina (-0.012, P = .047), and gastrointestinal events (-0.005, P = .430). MI and stroke reduced health-related quality of life beyond the year in which the event occurred (-0.031, P = .006, and -0.067, P < .001, respectively). CONCLUSIONS Acarbose treatment had no impact on health-related quality of life in ACE trial participants with CHD and IGT. Events such as MI, stroke, heart failure, and angina reduce health-related quality of life around the time they occurred, but only MI and stroke impacted on longer-term health-related quality of life.
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Affiliation(s)
- José Leal
- Health Economics Research CentreUniversity of OxfordOxfordUK
| | - Frauke Becker
- Health Economics Research CentreUniversity of OxfordOxfordUK
| | - Lee‐Ling Lim
- Department of MedicineUniversity of MalayaKuala LumpurMalaysia
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11
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Keng MJ, Leal J, Bowman L, Armitage J, Mihaylova B. Decrements in health-related quality of life associated with adverse events in people with diabetes. Diabetes Obes Metab 2022; 24:530-538. [PMID: 34866309 PMCID: PMC9361007 DOI: 10.1111/dom.14610] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Abstract
AIM To estimate the decrements in health-related quality of life (QoL) associated with a range of adverse events to inform assessments of the effects of diabetes treatments on QoL in contemporary clinical practice. METHODS Participants' QoL utility measures were derived from the five-level EuroQoL five-dimensional (EQ-5D-5L) questionnaires completed by 11 683 ASCEND participants (76% of 15 480 recruited). EQ-5D utility decrements associated with cardiovascular (myocardial infarction, coronary revascularization, transient ischaemic attack [TIA], ischaemic stroke, heart failure), bleeding (gastrointestinal [GI] bleed, intracranial haemorrhage, other major bleed), cancer (GI tract cancer, non-GI tract cancer), and microvascular events (end-stage renal disease [ESRD], amputation) were estimated using a linear regression model following adjustment for participants' sociodemographic and clinical risk factors. RESULTS Amputation was associated with the largest EQ-5D utility decrement (-0.206), followed by heart failure (-0.185), intracranial haemorrhage (-0.164), GI bleed (-0.091), other major bleed (-0.096), ischaemic stroke (-0.061), TIA (-0.057), and non-GI tract cancer (-0.026). We were unable to detect decrements in EQ-5D utility associated with myocardial infarction, coronary revascularization, GI tract cancer, or ESRD. EQ-5D utility was lower at older age, independent of other factors. CONCLUSION These estimated decrements in QoL associated with cardiovascular, bleeding, cancer, and other adverse events can inform assessments of the overall value of treatments in patients with diabetes.
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Affiliation(s)
- Mi Jun Keng
- Health Economics Research Centre, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- British Heart Foundation Centre of Research ExcellenceOxfordUK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Louise Bowman
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Jane Armitage
- British Heart Foundation Centre of Research ExcellenceOxfordUK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
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12
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Henstock L, Wong R, Tsuchiya A, Spencer A. Behavioral Theories That Have Influenced the Way Health State Preferences Are Elicited and Interpreted: A Bibliometric Mapping Analysis of the Time Trade-Off Method With VOSviewer Visualization. FRONTIERS IN HEALTH SERVICES 2022; 2:848087. [PMID: 36925791 PMCID: PMC10012726 DOI: 10.3389/frhs.2022.848087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022]
Abstract
Aim The aim of this paper is to develop an understanding of how behavioral theories have influenced the way preferences for health-related quality of life are elicited and interpreted. We focus on the Time Trade-off (TTO) method given it represents the quality-adjusted life-year (QALY) concept-that survival in less-than-full health can be deemed equivalent to a shorter survival in full health. To our knowledge this is the first review using a combination of systematic scoping review, bibliometrics and VOSviewer visualization to map the development of ideas in health economics. Methods A priori, we selected three behavioral theories to explore within our review, referred to here as Expected Utility Theory, Non-Expected Utility Theory and Probabilistic Choice Theory. A fourth topic, Order Effects, is defined broadly to encompass behavioral theories around timing/sequence of events. For the main search, Scopus was used to identify literature that had (a) elicited TTO values and/or (b) contributed to the way TTO values were elicited and interpreted, from inception to July 2021. Papers that focused on the latter category were given the label "behavioral" and underwent additional analyses. A two stage-screening was applied to assess eligibility. Co-citation, co-authorship and co-occurrence of keywords was used to chart the development of TTO over time. Results A total of 1,727 records were retrieved from Scopus and were supplemented by an additional 188 papers. There were 856 applied and 280 behavioral papers included in the final corpus, with the behavioral set split equally into four sets of 70 papers to chart the development of keywords over time: (1) 1972-1999; (2) 2000-2010, (3) 2010-2015 and (4) 2015-2021. Discussion The keyword analysis suggested that whilst some ideas transition quickly from economic theory to the TTO literature, such as the impact of Order Effects, others take longer to be assimilated, for example Non-Expected Utility models or failure of constant discounting. It is therefore important that researchers within health economics work more closely with those in mainstream economics and keep abreast of the wider economics and behavioral sciences to expedite the uptake of new and relevant ideas.
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Affiliation(s)
- Luke Henstock
- University of Birmingham, Birmingham, United Kingdom
| | - Ruth Wong
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Aki Tsuchiya
- Department of Economics and School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Anne Spencer
- Department of Health and Community Sciences, University of Exeter, Exeter, United Kingdom
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13
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Becker F, Dakin HA, Reed SD, Li Y, Leal J, Gustavson SM, Wittbrodt E, Hernandez AF, Gray AM, Holman RR. Lifetime cost-effectiveness simulation of once-weekly exenatide in type 2 diabetes: A cost-utility analysis based on the EXSCEL trial. Diabetes Res Clin Pract 2022; 183:109152. [PMID: 34813910 PMCID: PMC8844554 DOI: 10.1016/j.diabres.2021.109152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/15/2021] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
AIMS The Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial assessed once-weekly exenatide (EQW) vs. placebo, added to usual care in 14,752 patients with type 2 diabetes mellitus (Clinicaltrials.gov: NCT01144338). We assessed the lifetime cost-effectiveness of adding EQW vs. usual care alone from a healthcare perspective. METHODS Medical resource use and EQ-5D utilities were collected throughout the study. Within-trial results were extrapolated to a lifetime horizon using the UK Prospective Diabetes Study Outcomes Model version 2 (UKPDS-OM2), predicting predict cardiovascular and microvascular events. Cost-effectiveness was evaluated separately for US and UK settings, with outcomes measured in quality-adjusted life-years (QALYs). RESULTS EQW plus usual care gained 0.162 QALYs at an additional cost of $41,545/patient, compared with usual care in a US setting. The incremental cost-effectiveness ratio (ICER) was $259,223/QALY. In a UK setting, the QALY gain was 0.151 at an additional cost of £6357: an ICER of £42,589/QALY. Sensitivity analyses ranged between $34,369-$269,571 and £3430-£46,560 per QALY gained. CONCLUSIONS In a lifetime extrapolation, adding EQW to usual care increased QALYs and costs compared with usual care alone. The base-case ICERs exceeded the commonly-cited cost-effectiveness thresholds of $100,000/QALY and £20,000/QALY. However, ICERs were considerably lower in some subgroups, and in sensitivity analyses.
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Affiliation(s)
- Frauke Becker
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Helen A Dakin
- Health Economics Research Centre, University of Oxford, Oxford, UK.
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Yanhong Li
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - José Leal
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | | | - Eric Wittbrodt
- AstraZeneca Research and Development, Gaithersburg, MD, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Alastair M Gray
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Rury R Holman
- Diabetes Trials Unit, University of Oxford, Oxford, UK
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14
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A Systematic Review of Health State Utility Values in the Plastic Surgery Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3944. [PMID: 34849317 PMCID: PMC8615317 DOI: 10.1097/gox.0000000000003944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/15/2021] [Indexed: 01/23/2023]
Abstract
Cost-utility analyses assess health gains acquired by interventions by incorporating weighted health state utility values (HSUVs). HSUVs are important in plastic and reconstructive surgery (PRS) because they include qualitative metrics when comparing operative techniques or interventions. We systematically reviewed the literature to identify the extent and quality of existing original utilities research within PRS. Methods A systematic review of articles with original PRS utility data was conducted in accordance with the Preferred Reporting Items for a Systematic Review and Meta-Analysis guidelines. Subspecialty, survey sample size, and respondent characteristics were extracted. For each HSUV, the utility measure [direct (standard gamble, time trade off, visual analog scale) and/or indirect], mean utility score, and measure of variance were recorded. Similar HSUVs were pooled into weighted averages based on sample size if they were derived from the same utility measure. Results In total, 348 HSUVs for 194 disease states were derived from 56 studies within seven PRS subspecialties. Utility studies were most common in breast (n = 17, 30.4%) and hand/upper extremity (n = 15, 26.8%), and direct measurements were most frequent [visual analog scale (55.4%), standard gamble (46.4%), time trade off (57.1%)]. Studies surveying the general public had more respondents (n = 165, IQR 103-299) than those that surveyed patients (n = 61, IQR 48-79) or healthcare professionals (n = 42, IQR 10-109). HSUVs for 18 health states were aggregated. Conclusions The HSUV literature within PRS is scant and heterogeneous. Researchers should become familiar with these outcomes, as integrating utility and cost data will help illustrate that the impact of certain interventions are cost-effective when we consider patient quality of life.
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15
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Niño de Guzmán Quispe E, Martínez García L, Orrego Villagrán C, Heijmans M, Sunol R, Fraile-Navarro D, Pérez-Bracchiglione J, Ninov L, Salas-Gama K, Viteri García A, Alonso-Coello P. The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions: A Scoping Review of Reviews. THE PATIENT 2021; 14:719-740. [PMID: 33871808 PMCID: PMC8563562 DOI: 10.1007/s40271-021-00514-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Self-management (SM) interventions are supportive interventions systematically provided by healthcare professionals, peers, or laypersons to increase the skills and confidence of patients in their ability to manage chronic diseases. We had two objectives: (1) to summarise the preferences and experiences of patients and their caregivers (informal caregivers and healthcare professionals) with SM in four chronic diseases and (2) to identify and describe the relevant outcomes for SM interventions from these perspectives. METHODS We conducted a mixed-methods scoping review of reviews. We searched three databases until December 2020 for quantitative, qualitative, or mixed-methods reviews exploring patients' and caregivers' preferences or experiences with SM in type 2 diabetes mellitus (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart failure (HF). Quantitative data were narratively synthesised, and qualitative data followed a three-step descriptive thematic synthesis. Identified themes were categorised into outcomes or modifiable factors of SM interventions. RESULTS We included 148 reviews covering T2DM (n = 53 [35.8%]), obesity (n = 20 [13.5%]), COPD (n = 32 [21.6%]), HF (n = 38 [25.7%]), and those with more than one disease (n = 5 [3.4%]). We identified 12 main themes. Eight described the process of SM (disease progression, SM behaviours, social support, interaction with healthcare professionals, access to healthcare, costs for patients, culturally defined roles and perceptions, and health knowledge), and four described their experiences with SM interventions (the perceived benefit of the intervention, individualised care, sense of community with peers, and usability of equipment). Most themes and subthemes were categorised as outcomes of SM interventions. CONCLUSION The process of SM shaped the perspectives of patients and their caregivers on SM interventions. Their perspectives were influenced by the perceived benefit of the intervention, the sense of community with peers, the intervention's usability, and the level of individualised care. Our findings can inform the selection of patient-important outcomes, decision-making processes, including the formulation of recommendations, and the design and implementation of SM interventions.
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Affiliation(s)
- Ena Niño de Guzmán Quispe
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain.
| | - Laura Martínez García
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carola Orrego Villagrán
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Rosa Sunol
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Fraile-Navarro
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Madrid Primary Health Care Service, Madrid, Spain
| | | | | | - Karla Salas-Gama
- Health Services Research Group, Institut de Recerca Vall d'Hebron Hospital, Barcelona, Spain
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrés Viteri García
- Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Universidad UTE, Quito, Ecuador
- Centro Asociado Cochrane de Ecuador, Universidad UTE, Quito, Ecuador
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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16
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Kuo S, Yang C, Chen H, Ou H. Valuing health states of people with type 2 diabetes: Analyses of the nationwide representative linked databases. J Diabetes Investig 2021; 12:1749-1758. [PMID: 33539655 PMCID: PMC8409834 DOI: 10.1111/jdi.13520] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS/INTRODUCTION To estimate preference-based measures of health-related quality of life associated with sociodemographic and clinical characteristics in type 2 diabetes patients. MATERIALS AND METHODS Individuals with EuroQol-5 dimensions-3 levels data were identified from Taiwan's National Health Interview Survey in 2009 and 2013. Status of diabetes, comorbidities, complications and treatments were ascertained through data linkage to Taiwan's National Health Insurance Research Database. Multivariable ordinary least squares, Tobit and median regression analyses were used to estimate the coefficients that represented independent impacts of patients' characteristics on health-related quality of life. RESULTS The mean health utility score for 2,104 participants was 0.838. Being female, aging, divorced/widowed, never worked or underweight, or having a lower monthly household income, injectable glucose-lowering therapy, comorbid connective tissue disease or depression were associated with lower health utilities. Having an amputation led to the largest reduction by 0.288 in health utilities, followed by debilitating stroke (0.266), heart failure (0.237), other coronary heart disease (0.185), kidney dialysis/transplant (0.148), coronary revascularizations (0.093), transient ischemic attack/stroke (0.078), diabetic neuropathy (0.062), polyneuropathy (0.055) and other neuropathy (0.043). CONCLUSIONS Major vascular complications, connective tissue disease and depression are associated with considerably worse health-related quality of life. These health utility estimates can facilitate health economic evaluations to determine cost-effective strategies for diabetes management.
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Affiliation(s)
- Shihchen Kuo
- Division of Metabolism, Endocrinology & DiabetesDepartment of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Chun‐Ting Yang
- Institute of Clinical Pharmacy and Pharmaceutical SciencesCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Hsuan‐Ying Chen
- Institute of Clinical Pharmacy and Pharmaceutical SciencesCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Huang‐Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical SciencesCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of PharmacyCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of PharmacyNational Cheng Kung University HospitalTainanTaiwan
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17
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Yuan Y, Xiao Y, Chen X, Li J, Shen M. A Systematic Review and Meta-Analysis of Health Utility Estimates in Chronic Spontaneous Urticaria. Front Med (Lausanne) 2021; 7:543290. [PMID: 33425930 PMCID: PMC7793814 DOI: 10.3389/fmed.2020.543290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Chronic spontaneous urticaria (CSU) is a common recurrent skin disease that adversely affect patient's quality of life condition to treat. Economic evaluations of health care often include patient preferences for health outcomes using utilities. Objectives: The study aimed to determine pooled estimates of utility-based quality of life in patients with CSU. Methods: We conducted a systematic review, meta-analysis, and meta-regression of peer-reviewed articles and conference papers that published from database inception to 31 April 2019 that reported utility estimates in patients with CSU. Scores reported with the EQ-5D, SF-6D, SF-12, and SF-36 instruments were converted to utilities using published mapping algorithms. Meta-analysis was used to calculate the pooled and meta-regression was used to examine the effects of possible factors. Results: The pooled utility estimate for CSU was 0.68 [95% confidence interval (CI): 0.67–0.70]. The pooled utility estimate that converted from SF-36 or SF-12 was 0.66 (95% CI: 0.58–0.74), 0.72 (95% CI: 0.70–0.74) for EQ-5D, and 0.65 (95% CI: 0.63–0.67) for SF-6D, respectively. According to the meta-regression, higher proportion of female patients was significantly associated lower utility estimates (p = 0.013). Conclusions: The study provides evidence-based utility estimates to inform health-related burden analysis of CSU and reference for the follow-up cost-effectiveness evaluation of chronic spontaneous urticaria intervention. These results highlight differences in common utility-based instruments and need to be cognizant of the specific instruments used when comparing the results of outcome studies.
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Affiliation(s)
- Yan Yuan
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Jie Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China.,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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Leal J, Reed SD, Patel R, Rivero-Arias O, Li Y, Schulman KA, Califf RM, Holman RR, Gray AM. Benchmarking the Cost-Effectiveness of Interventions Delaying Diabetes: A Simulation Study Based on NAVIGATOR Data. Diabetes Care 2020; 43:2485-2492. [PMID: 32796009 PMCID: PMC7510029 DOI: 10.2337/dc20-0717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/13/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate using the UK Prospective Diabetes Study Outcomes Model Version 2 (UKPDS-OM2) the impact of delaying type 2 diabetes onset on costs and quality-adjusted life expectancy using trial participants who developed diabetes in the NAVIGATOR (Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research) study. RESEARCH DESIGN AND METHODS We simulated the impact of delaying diabetes onset by 1-9 years, utilizing data from the 3,058 of 9,306 NAVIGATOR trial participants who developed type 2 diabetes. Costs and utility weights associated with diabetes and diabetes-related complications were obtained for the U.S. and U.K. settings, with costs expressed in 2017 values. We estimated discounted lifetime costs and quality-adjusted life years (QALYs) with 95% CIs. RESULTS Gains in QALYs increased from 0.02 (U.S. setting, 95% CI 0.01, 0.03) to 0.15 (U.S. setting, 95% CI 0.10, 0.21) as the imposed time to diabetes onset was increased from 1 to 9 years, respectively. Savings in complication costs increased from $1,388 (95% CI $1,092, $1,669) for a 1-year delay to $8,437 (95% CI $6,611, $10,197) for a delay of 9 years. Interventions costing up to $567-$2,680 and £201-£947 per year would be cost-effective at $100,000 per QALY and £20,000 per QALY thresholds in the U.S. and U.K., respectively, as the modeled delay in diabetes onset was increased from 1 to 9 years. CONCLUSIONS Simulating a hypothetical diabetes-delaying intervention provides guidance concerning the maximum cost and minimum delay in diabetes onset needed to be cost-effective. These results can inform the ongoing debate about diabetes prevention strategies and the design of future intervention studies.
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Affiliation(s)
- Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, U.K.
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Rishi Patel
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Yanhong Li
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Robert M Califf
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Rury R Holman
- Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, U.K
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
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19
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Xia Q, Campbell JA, Ahmad H, Si L, de Graaff B, Otahal P, Palmer AJ. Health state utilities for economic evaluation of bariatric surgery: A comprehensive systematic review and meta-analysis. Obes Rev 2020; 21:e13028. [PMID: 32497417 DOI: 10.1111/obr.13028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 11/27/2022]
Abstract
Health state utilities (HSUs) are health economic metrics that capture and assess health-related quality of life (HRQoL). They are essential in health-economic evaluations when calculating quality-adjusted life years. We investigated published studies reporting bariatric surgery-related HSUs elicited through direct or indirect (multiattribute utility instrument [MAUI]) patient-reported methods (PROSPERO registration number: CRD42019131725). Mean HSUs for different time points and HSU changes over time (where feasible) were meta-analysed using random-effects models. Of the 950 potentially relevant identified studies, n = 28 (2004-2018) qualified for data extraction, with n = 85 unique HSUs elicited mainly from the EQ-5D (88%). Most (75%) studies were published after 2013. The follow-up duration varied between studies and was often limited to 12 months. The pooled mean HSU was 0.72 (0.67-0.76) at baseline/presurgery (n = 18) and 0.84 (0.79-0.89) one-year postsurgery (n = 11), indicating a 0.11 (0.09-0.14) utility unit increment. EQ-5D showed the similar results. This positive difference can be partially explained by BMI and/or co-morbidities status improvement. This study provides a valuable summary of HSUs to future bariatric surgery-related cost-utility models. However, more well-designed higher-quality bariatric-related HSU studies are expected for future reviews to improve the available evidence. We suggest that researchers select an MAUI that is preferentially sensitive to the study population.
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Affiliation(s)
- Qing Xia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Centre for Health Economics, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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20
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Shafie AA, Ng CH. Cost-Effectiveness of Insulin Glargine and Insulin Detemir in the Basal Regimen for Naïve Insulin Patients with Type 2 Diabetes Mellitus (T2DM) in Malaysia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:333-343. [PMID: 32606850 PMCID: PMC7319511 DOI: 10.2147/ceor.s244884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/29/2020] [Indexed: 12/20/2022] Open
Abstract
Objective To compare the cost-effectiveness of long-acting insulin analogue (LAIA) (insulin Detemir and insulin Glargine) versus NPH insulin in the basal insulin regime for naïve insulin T2DM Malaysian patients. Methods The UKPDS-Outcome Model version 2.0 (UKPDS-OM2) was used to evaluate the cost and consequence of diabetes-related complication. The effectiveness of the insulin was derived from the literature review, and the patients’ epidemiology characteristics were retrieved from the Malaysian Diabetes Registry. A discount rate of 3% was applied to both costs and health effects. Another simple mathematical model was used to compare the benefit of reducing the hypoglycemia events between LAIA and NPH insulin. The outputs of the models were combined to obtain the final result. One-way sensitivity analyses were performed to assess the uncertainties. Results The net cost difference (without accounting for hypoglycemia) was RM4868 for insulin Glargine and RM6026 for insulin Detemir. The saving from preventing severe hypoglycemia was RM4377 for insulin Glargine and RM12,753 for insulin Detemir. The total additional QALY gained from insulin Glargine was 0.1317 and from insulin Detemir was 0.8376. The sensitivity analysis shows the discount rate, and drug acquisition cost may affect the incremental cost-effectiveness ratio (ICER) value. Conclusion Both insulin Detemir and Glargine are cost-effective compared to NPH insulin for T2DM patients, especially when the benefit of reducing the hypoglycemia event rate is taken into account.
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Affiliation(s)
- Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Penang, Malaysia
| | - Chin Hui Ng
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ipoh 30450, Perak, Malaysia
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21
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Gu S, Wang X, Shi L, Sun Q, Hu X, Gu Y, Sun X, Dong H. Health-related quality of life of type 2 diabetes patients hospitalized for a diabetes-related complication. Qual Life Res 2020; 29:2695-2704. [DOI: 10.1007/s11136-020-02524-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 01/19/2023]
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22
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López-Bastida J, López-Siguero JP, Oliva-Moreno J, Vázquez LA, Aranda-Reneo I, Reviriego J, Dilla T, Perez-Nieves M. Health-related quality of life in type 1 diabetes mellitus pediatric patients and their caregivers in Spain: an observational cross-sectional study. Curr Med Res Opin 2019; 35:1589-1595. [PMID: 30964364 DOI: 10.1080/03007995.2019.1605158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objectives: This study assessed the health-related quality of life (HRQOL) of pediatric patients with type 1 diabetes mellitus (T1DM) and their caregivers.Methods: CHRYSTAL was an observational cross-sectional study conducted in Spain in 2014 on 275 patients under 18 years old diagnosed with T1DM. Patient/caregiver pairs were stratified by patients' HbA1c level (≥7.5% versus <7.5%) and by presence or absence of T1DM complications and/or comorbidities. EQ-5D and PedsQL questionnaires were administered to patients and caregivers.Results: On the EQ-5D, according to caregivers' perception, 17.7% of children experienced moderate pain or discomfort, 9.7% suffered problems performing usual activities, and 13.2% demonstrated moderate anxiety or depression. Mean EQ-5D index score was 0.95 and mean visual analog scale (VAS) score was 86.1. By HbA1c level (≥7.5% versus <7.5%), mean index scores were 0.94 and 0.95, and mean VAS scores were 82.8 and 89.2, respectively. Mean index scores were 0.91 for children with complications and/or comorbidities and 0.96 for children without. Mean VAS scores were 83.7 and 87.2, respectively. HRQOL per the PedsQL tool ranged from 68.1 (ages 2-4) to 73.1 (ages 13-18). EQ-5D index and VAS scores were significantly correlated (rho = 0.29-0.43) with several age groups of the PedsQL. EQ-5D scales showed significant moderate correlation between EQ-5D-Y and EQ-5D-3L proxy VAS score (rho = 0.45; p < .001).Conclusions: Patients with few complications and controlled HbA1c reported a relatively high HRQOL. The results suggest that parent-proxy EQ-5D ratings are valid for use as part of an overall health outcomes assessment in clinical studies of T1DM in pediatric patients.
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Affiliation(s)
- Julio López-Bastida
- Faculty of Occupational Therapy, Speech Therapy and Nursing, University of Castilla-La Mancha, Toledo, Spain
| | | | - Juan Oliva-Moreno
- Department of Economics and Finance, University of Castilla-La Mancha, Toledo, Spain
| | - Luis Alberto Vázquez
- Department of Endocrinology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Isaac Aranda-Reneo
- Faculty of Occupational Therapy, Speech Therapy and Nursing, University of Castilla-La Mancha, Toledo, Spain
| | | | - Tatiana Dilla
- Health Outcomes, Eli Lilly and Company, Madrid, Spain
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Shao H, Yang S, Fonseca V, Stoecker C, Shi L. Estimating Quality of Life Decrements Due to Diabetes Complications in the United States: The Health Utility Index (HUI) Diabetes Complication Equation. PHARMACOECONOMICS 2019; 37:921-929. [PMID: 30778865 PMCID: PMC7220804 DOI: 10.1007/s40273-019-00775-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Health utility decrements associated with diabetes mellitus complications are essential for calculating quality-adjusted life-years (QALYs) in patients for use in economic evaluation of diabetes interventions. Previous studies mostly focused on assessing the impact of complications on health utility at event year based on cross-sectional data. This study aimed to separately estimate health utility decrements associated with current and previous diabetes complications. RESEARCH DESIGN AND METHODS The Health Utilities Index Mark 3 (HUI-3) was used to measure heath utility in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial (N = 8713). Five macrovascular complications (myocardial infarction [MI], congestive heart failure [CHF], stroke, angina, and revascularization surgery [RS]) and three microvascular complications (nephropathy [renal failure], retinopathy [severe vision loss], and neuropathy [severe pressure sensation loss]) were included in a set of alternative modelling approaches including the ordinary least squares (OLS) model, fixed effects model, and random effects model to estimate the complication-related health utility decrements. RESULTS All macrovascular complications were associated with decrements of HUI-3 scores: MI (event year: - 0.042, successive years: - 0.011), CHF (event year: - 0.089, successive years: - 0.041), stroke (event year: - 0.204, successive years: - 0.101), angina (event year: - 0.010, successive years: - 0.032), and revascularization (event year: - 0.038, successive years: - 0.016) (all p < 0.05). For microvascular complications, severe vision loss (- 0.057), and severe pressure sensation loss (- 0.066) were significantly associated with decrements of HUI-3 scores (both p < 0.05). Hypoglycemia (both severe and symptomatic) was found to be associated with a 0.036 decrement of health utility at event year, and a 0.033 decrement of health utility at successive years. Results from an OLS model are preferred for supporting a microsimulation model while a fixed effects model is preferred to describe direct health impacts from complications. CONCLUSIONS Macrovascular and microvascular complications caused QALY decrements in patients with type 2 diabetes. While only part of the total impaired QALY is experienced during the event year, further QALY decrements for successive years were quite substantial.
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Affiliation(s)
- Hui Shao
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA
| | - Shuang Yang
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA
| | - Vivian Fonseca
- School of Medicine, Tulane University, New Orleans, LA, USA
| | - Charles Stoecker
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA.
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Hall PS, Mitchell ED, Smith AF, Cairns DA, Messenger M, Hutchinson M, Wright J, Vinall-Collier K, Corps C, Hamilton P, Meads D, Lewington A. The future for diagnostic tests of acute kidney injury in critical care: evidence synthesis, care pathway analysis and research prioritisation. Health Technol Assess 2019; 22:1-274. [PMID: 29862965 DOI: 10.3310/hta22320] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is highly prevalent in hospital inpatient populations, leading to significant mortality and morbidity, reduced quality of life and high short- and long-term health-care costs for the NHS. New diagnostic tests may offer an earlier diagnosis or improved care, but evidence of benefit to patients and of value to the NHS is required before national adoption. OBJECTIVES To evaluate the potential for AKI in vitro diagnostic tests to enhance the NHS care of patients admitted to the intensive care unit (ICU) and identify an efficient supporting research strategy. DATA SOURCES We searched ClinicalTrials.gov, The Cochrane Library databases, Embase, Health Management Information Consortium, International Clinical Trials Registry Platform, MEDLINE, metaRegister of Current Controlled Trials, PubMed and Web of Science databases from their inception dates until September 2014 (review 1), November 2015 (review 2) and July 2015 (economic model). Details of databases used for each review and coverage dates are listed in the main report. REVIEW METHODS The AKI-Diagnostics project included horizon scanning, systematic reviewing, meta-analysis of sensitivity and specificity, appraisal of analytical validity, care pathway analysis, model-based lifetime economic evaluation from a UK NHS perspective and value of information (VOI) analysis. RESULTS The horizon-scanning search identified 152 potential tests and biomarkers. Three tests, Nephrocheck® (Astute Medical, Inc., San Diego, CA, USA), NGAL and cystatin C, were subjected to detailed review. The meta-analysis was limited by variable reporting standards, study quality and heterogeneity, but sensitivity was between 0.54 and 0.92 and specificity was between 0.49 and 0.95 depending on the test. A bespoke critical appraisal framework demonstrated that analytical validity was also poorly reported in many instances. In the economic model the incremental cost-effectiveness ratios ranged from £11,476 to £19,324 per quality-adjusted life-year (QALY), with a probability of cost-effectiveness between 48% and 54% when tests were compared with current standard care. LIMITATIONS The major limitation in the evidence on tests was the heterogeneity between studies in the definitions of AKI and the timing of testing. CONCLUSIONS Diagnostic tests for AKI in the ICU offer the potential to improve patient care and add value to the NHS, but cost-effectiveness remains highly uncertain. Further research should focus on the mechanisms by which a new test might change current care processes in the ICU and the subsequent cost and QALY implications. The VOI analysis suggested that further observational research to better define the prevalence of AKI developing in the ICU would be worthwhile. A formal randomised controlled trial of biomarker use linked to a standardised AKI care pathway is necessary to provide definitive evidence on whether or not adoption of tests by the NHS would be of value. STUDY REGISTRATION The systematic review within this study is registered as PROSPERO CRD42014013919. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Peter S Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | | | - Alison F Smith
- Academy of Primary Care, Hull York Medical School, Hull, UK.,National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Leeds, Leeds, UK
| | - David A Cairns
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael Messenger
- National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Leeds, Leeds, UK
| | | | - Judy Wright
- Academy of Primary Care, Hull York Medical School, Hull, UK
| | | | | | - Patrick Hamilton
- Manchester Institute of Nephrology and Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - David Meads
- Academy of Primary Care, Hull York Medical School, Hull, UK
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25
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Arifin B, Idrus LR, van Asselt ADI, Purba FD, Perwitasari DA, Thobari JA, Cao Q, Krabbe PFM, Postma MJ. Health-related quality of life in Indonesian type 2 diabetes mellitus outpatients measured with the Bahasa version of EQ-5D. Qual Life Res 2019; 28:1179-1190. [PMID: 30649698 PMCID: PMC6470109 DOI: 10.1007/s11136-019-02105-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 01/31/2023]
Abstract
Objectives To present EuroQol-5D (EQ-5D) index scores in Indonesian type 2 diabetes mellitus (T2DM) outpatients and to investigate the associations between EQ-5D and socio-demographic characteristics and clinical condition. Methods Socio-demographic data were collected by interviewing participants, clinical data were obtained from treating physicians and self-reporting. Participants originated from primary and secondary care facilities in the Java and Sulawesi regions. Ordinal regression analysis was conducted with the quintiles of the EQ-5D index scores as the dependent variable to investigate the multivariate association with the participants’ socio-demographic characteristics and clinical condition. Results 907 participants completed the five-level Indonesian version of the EQ-5D. The mean age of the participants was 59.3 (SD 9.7), and 57% were female. The overall EQ-5D index score was 0.77 (0.75–0.79). Male participants had a higher EQ-5D index score compared to females, and the highest percentage of self-reported health problems was in the pain/discomfort dimension (61%). Factors identified as being significantly associated with lower EQ-5D index scores were: (i) treatment in secondary care, (ii) lower educational level, (iii) dependency on caregivers, (iv) not undergoing T2DM therapy, and (v) being a housewife. Conclusion This study provides estimates of EQ-5D index scores that can be used in health economic evaluations. As housewives were found to experience more T2DM-related pain/discomfort and anxiety/depression, targeted approaches to reduce these problems should be aimed specifically at this group of patients. Potential approaches could involve disease-specific-counselors (health literacy partners) who provide routine monitoring of T2DM therapy as well as improved health promotion among T2DM communities.
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Affiliation(s)
- Bustanul Arifin
- Unit of Pharmacotherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, Faculty of Science and Engineering (FSE), University of Groningen, Groningen, The Netherlands. .,Banggai Laut Public Hospital, Banggai Laut Local Government, Central Sulawesi, Indonesia. .,Institute of Science in Healthy Ageing & healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
| | - Lusiana Rusdi Idrus
- Unit of Pharmacotherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, Faculty of Science and Engineering (FSE), University of Groningen, Groningen, The Netherlands.,Institute of Science in Healthy Ageing & healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.,Bekasi General Hospital, West Java Local Government, Bekasi, Indonesia
| | - Antoinette D I van Asselt
- Unit of Pharmacotherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, Faculty of Science and Engineering (FSE), University of Groningen, Groningen, The Netherlands.,Institute of Science in Healthy Ageing & healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Fredrick Dermawan Purba
- Department of Psychiatry, Medical Psychology and Psychotherapy Section, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Developmental Psychology, Faculty of Psychology, Padjadjaran University, Jatinangor, Indonesia
| | | | - Jarir At Thobari
- Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Qi Cao
- Unit of Pharmacotherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, Faculty of Science and Engineering (FSE), University of Groningen, Groningen, The Netherlands
| | - Paul F M Krabbe
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Unit of Pharmacotherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, Faculty of Science and Engineering (FSE), University of Groningen, Groningen, The Netherlands.,Institute of Science in Healthy Ageing & healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.,Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Departement of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, Netherlands.,Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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Petrou S, Kwon J, Madan J. A Practical Guide to Conducting a Systematic Review and Meta-analysis of Health State Utility Values. PHARMACOECONOMICS 2018; 36:1043-1061. [PMID: 29750430 DOI: 10.1007/s40273-018-0670-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Economic analysts are increasingly likely to rely on systematic reviews and meta-analyses of health state utility values to inform the parameter inputs of decision-analytic modelling-based economic evaluations. Beyond the context of economic evaluation, evidence from systematic reviews and meta-analyses of health state utility values can be used to inform broader health policy decisions. This paper provides practical guidance on how to conduct a systematic review and meta-analysis of health state utility values. The paper outlines a number of stages in conducting a systematic review, including identifying the appropriate evidence, study selection, data extraction and presentation, and quality and relevance assessment. The paper outlines three broad approaches that can be used to synthesise multiple estimates of health utilities for a given health state or condition, namely fixed-effect meta-analysis, random-effects meta-analysis and mixed-effects meta-regression. Each approach is illustrated by a synthesis of utility values for a hypothetical decision problem, and software code is provided. The paper highlights a number of methodological issues pertinent to the conduct of meta-analysis or meta-regression. These include the importance of limiting synthesis to 'comparable' utility estimates, for example those derived using common utility measurement approaches and sources of valuation; the effects of reliance on limited or poorly reported published data from primary utility assessment studies; the use of aggregate outcomes within analyses; approaches to generating measures of uncertainty; handling of median utility values; challenges surrounding the disentanglement of utility estimates collected serially within the context of prospective observational studies or prospective randomised trials; challenges surrounding the disentanglement of intervention effects; and approaches to measuring model validity. Areas of methodological debate and avenues for future research are highlighted.
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Affiliation(s)
- Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Joseph Kwon
- School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
| | - Jason Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Brown V, Tan EJ, Hayes AJ, Petrou S, Moodie ML. Utility values for childhood obesity interventions: a systematic review and meta-analysis of the evidence for use in economic evaluation. Obes Rev 2018; 19:905-916. [PMID: 29356315 DOI: 10.1111/obr.12672] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/12/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
Abstract
Rigorous estimates of preference-based utilities are important inputs into economic evaluations of childhood obesity interventions, yet no published review currently exists examining utility by weight status in paediatric populations. A comprehensive systematic literature review and meta-analysis was therefore undertaken, pooling data on preference-based health state utilities by weight status in children using a random-effects model. Tests for heterogeneity were performed, and publication bias was assessed. Of 3,434 potentially relevant studies identified, 11 met our eligibility criteria. Estimates of Cohen's d statistic suggested a small effect of weight status on preference-based utilities. Mean utility values were estimated as 0.85 (95% uncertainty interval [UI] 0.84-0.87), 0.83 (95% UI 0.81-0.85), 0.82 (95% UI 0.79-0.84) and 0.83 (95% UI 0.80-0.86) for healthy weight, overweight, obese and overweight/obese states, respectively. Meta-analysis of studies reporting utility values for both healthy weight and overweight/obese participants found a statistically significant weighted mean difference (0.015, 95% UI 0.003-0.026). A small but statistically significant difference was also estimated between healthy weight and overweight participants (0.011, 95% UI 0.004-0.018). Study findings suggest that paediatric-specific benefits of obesity interventions may not be well reflected by available utility measures, potentially underestimating cost-effectiveness if weight loss in childhood/adolescence improves health or well-being.
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Affiliation(s)
- V Brown
- Deakin Health Economics, Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia.,Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
| | - E J Tan
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - A J Hayes
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - S Petrou
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,Warwick Medical School, University of Warwick, Coventry, UK
| | - M L Moodie
- Deakin Health Economics, Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia.,Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
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Nguyen E, Coleman CI, Nair S, Weeda ER. Cost-utility of empagliflozin in patients with type 2 diabetes at high cardiovascular risk. J Diabetes Complications 2018; 32:210-215. [PMID: 29157870 DOI: 10.1016/j.jdiacomp.2017.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 01/09/2023]
Abstract
AIMS In the Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG) trial, empagliflozin reduced cardiovascular and all-cause mortality in type 2 diabetes (T2D) patients at high cardiovascular risk. We sought to estimate the cost-effectiveness of empagliflozin versus standard treatment for the prevention of cardiovascular morbidity and mortality in patients with T2D. METHODS A Markov model was developed to assess the cost-effectiveness of empagliflozin (versus standard treatment) for the prevention of cardiovascular morbidity and mortality in patients with T2D using a 3-month cycle length and a lifetime horizon. Data sources included the EMPA-REG randomized clinical trial and other published epidemiological studies. Outcomes included treatment costs (in 2016 US$), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Probabilistic sensitivity analysis (PSA) was performed to test the robustness of conclusions. RESULTS Empagliflozin use resulted in higher total lifetime treatment costs ($371,450 versus $272,966) but yielded greater QALYs (10.712 vs. 9.419) compared to standard treatment. This corresponded to an ICER of $76,167 per QALY gained. PSA suggested empagliflozin would be cost-effective in 96% of 10,000 iterations assuming a willingness-to-pay threshold of $100,000 per QALY gained. CONCLUSION Empagliflozin may be cost-effective compared to standard treatment in T2D patients at high cardiovascular risk.
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Affiliation(s)
- Elaine Nguyen
- Idaho State University, College of Pharmacy, Meridian, ID, USA
| | - Craig I Coleman
- University of Connecticut, Hartford Hospital Evidence-Based Practice Center, Hartford, CT, USA
| | - Suresh Nair
- University of Connecticut, School of Business, Hartford, CT, USA
| | - Erin R Weeda
- Medical University of South Carolina, College of Pharmacy, Charleston, SC, USA.
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Blieden Betts M, Gandra SR, Cheng LI, Szatkowski A, Toth PP. Differences in utility elicitation methods in cardiovascular disease: a systematic review. J Med Econ 2018; 21:74-84. [PMID: 28899233 DOI: 10.1080/13696998.2017.1379410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS Utility values inform estimates of the cost-effectiveness of treatment for cardiovascular disease (CVD), but values can vary depending on the method used. The aim of this systematic literature review (SLR) was to explore how methods of elicitation impact utility values for CVD. MATERIALS AND METHODS This review identified English-language articles in Embase, MEDLINE, and the gray literature published between September 1992 and August 2015 using keywords for "utilities" and "stroke", "heart failure", "myocardial infarction", or "angina". Variability in utility values based on the method of elicitation, tariff, or type of respondent was then reported. RESULTS This review screened 4,341 citations; 290 of these articles qualified for inclusion in the SLR because they reported utility values for one or more of the cardiovascular conditions of interest listed above. Of these 290, the 41 articles that provided head-to-head comparisons of utility methods for CVD were reviewed. In this sub-set, it was found that methodological differences contributed to variation in utility values. Direct methods often yielded higher scores than did indirect methods. Within direct methods, there were no clear trends in head-to-head studies (standard gamble [SG] vs time trade-off); but general population respondents often provided lower scores than did patients with the disease when evaluating the same health states with SG methods. When comparing indirect methods, the EQ-5D typically yielded higher values than the SF-6D, but also showed more sensitivity to differences in health states. CONCLUSIONS When selecting CVD utility values for an economic model, consideration of the utility elicitation method is important, as this review demonstrates that methodology of choice impacts utility values in CVD.
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Affiliation(s)
| | | | - Lung-I Cheng
- c Takeda Oncology , Cambridge , MA , USA (current)
| | | | - Peter P Toth
- d CGH Medical Center , Sterling , IL , USA
- e Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Pollock RF, Chubb B, Valentine WJ, Heller S. Evaluating the cost-effectiveness of insulin detemir versus neutral protamine Hagedorn insulin in patients with type 1 or type 2 diabetes in the UK using a short-term modeling approach. Diabetes Metab Syndr Obes 2018; 11:217-226. [PMID: 29844693 PMCID: PMC5962301 DOI: 10.2147/dmso.s156739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND To estimate the short-term cost-effectiveness of insulin detemir (IDet) versus neutral protamine Hagedorn (NPH) insulin based on the incidence of non-severe hypoglycemia and changes in body weight in subjects with type 1 diabetes (T1D) or type 2 diabetes (T2D) in the UK. METHODS A model was developed to evaluate cost-effectiveness based on non-severe hypoglycemia, body mass index, and pharmacy costs over 1 year. Published rates of non-severe hypoglycemia were employed in the T1D and T2D analyses, while reduced weight gain with IDet was modeled in the T2D analysis only. Effectiveness was calculated in terms of quality-adjusted life expectancy using published utility scores. Pharmacy costs were captured using published prices and defined daily doses. Costs were expressed in 2016 pounds sterling (GBP). Sensitivity analyses were performed (including probabilistic sensitivity analysis). RESULTS In T1D, IDet was associated with fewer non-severe hypoglycemic events than NPH insulin (126.7 versus 150.8 events per person-year), leading to an improvement of 0.099 quality-adjusted life years (QALYs). Costs with IDet were GBP 60 higher, yielding an incremental cost-effectiveness ratio (ICER) of GBP 610 per QALY gained. In T2D, mean non-severe hypoglycemic event rates and body weight were lower with IDet than NPH insulin, leading to a total incremental utility of 0.120, accompanied by an annual cost increase of GBP 171, yielding an ICER of GBP 1,422 per QALY gained for IDet versus NPH insulin. CONCLUSION Short-term health economic evaluation showed IDet to be a cost-effective alternative to NPH insulin in the UK due to lower rates of non-severe hypoglycemia (T1D and T2D) and reduced weight gain (T2D only).
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Affiliation(s)
- Richard F Pollock
- Health Economics and Outcomes Research, Ossian Health Economics and Communications GmbH, Basel, Switzerland
- Correspondence: Richard F Pollock, Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051 Basel, Switzerland, Tel +41 61 271 6214, Email
| | | | - William J Valentine
- Health Economics and Outcomes Research, Ossian Health Economics and Communications GmbH, Basel, Switzerland
| | - Simon Heller
- Department of Oncology & Metabolism, The University of Sheffield, Sheffield, UK
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Peña-Longobardo LM, Rodríguez-Sánchez B, Mata-Cases M, Rodríguez-Mañas L, Capel M, Oliva-Moreno J. Is quality of life different between diabetic and non-diabetic people? The importance of cardiovascular risks. PLoS One 2017; 12:e0189505. [PMID: 29240836 PMCID: PMC5730158 DOI: 10.1371/journal.pone.0189505] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022] Open
Abstract
Background To analyse and compare the impact of cardiovascular risk factors and disease on health-related quality of life (HRQoL) in people with and without diabetes living in the community. Methods We used data of 1,905 people with diabetes and 19,031 people without diabetes from the last Spanish National Health Survey (years 2011–2012). The HRQoL instrument used was the EuroQol 5D-5L, based on time trade-off scores. Matching methods were used to assess any differences in the HRQoL in people with and without diabetes with the same characteristics (age, gender, education level, and healthy lifestyle), according to cardiovascular risk factors and diseases. Disparities were also analysed for every dimension of HRQoL: mobility, daily activities, personal care, pain/discomfort, and anxiety/depression. Results There were no significant differences in time trade-off scores between people with and without diabetes when cardiovascular risk factors or established cardiovascular disease were not present. However, when cardiovascular risk factors were present, the HRQoL score was significantly lower in people with diabetes than in those without. This difference was indeed greater when cardiovascular diseases were present. More precisely, people with diabetes and any of the cardiovascular risk factors, who have not yet developed any cardiovascular disease, report lower HRQoL, 0.046 TTO score points over 1 (7.93 over 100 in the VAS score) compared to those without diabetes, and 0.14 TTO score points of difference (14.61 over 100 in the VAS score) if cardiovascular diseases were present. In fact, when the three risk factors were present in people with diabetes, HRQoL was significantly lower (0.10 TTO score points over 1 and 10.86 points over 100 in VAS score), obesity being the most influential risk factor. Conclusions The presence of established cardiovascular disease and/or cardiovascular risk factors, specially obesity, account for impaired quality of life in people with diabetes.
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Affiliation(s)
- L. M. Peña-Longobardo
- University of Castilla-La Mancha, Department of Economic Analysis and Finance, Toledo, Spain
- * E-mail:
| | - B. Rodríguez-Sánchez
- University of Groningen, Department of Economics, Econometrics and Finance, Groningen, The Netherlands
| | - M. Mata-Cases
- Primary Health Care Center La Mina, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - M. Capel
- Astrazeneca, Health Economics and Outcomes Research, Madrid, Spain
| | - J. Oliva-Moreno
- University of Castilla-La Mancha, Department of Economic Analysis and Finance, Toledo, Spain
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Critselis E, Vlahou A, Stel VS, Morton RL. Cost-effectiveness of screening type 2 diabetes patients for chronic kidney disease progression with the CKD273 urinary peptide classifier as compared to urinary albumin excretion. Nephrol Dial Transplant 2017; 33:441-449. [DOI: 10.1093/ndt/gfx068] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/16/2017] [Indexed: 12/23/2022] Open
Affiliation(s)
- Elena Critselis
- Proteomics Laboratory, Center for Basic Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Antonia Vlahou
- Proteomics Laboratory, Center for Basic Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Rachael L Morton
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
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Health-related quality of life and health preference of Chinese patients with diabetes mellitus managed in primary care and secondary care setting: decrements associated with individual complication and number of complications. Health Qual Life Outcomes 2017; 15:125. [PMID: 28610625 PMCID: PMC5470199 DOI: 10.1186/s12955-017-0699-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 06/04/2017] [Indexed: 01/19/2023] Open
Abstract
Background Health-related quality of life (HRQoL) and health preference of patients with diabetes mellitus (DM) are essential in health economic evaluations but data on Chinese population is rare. This study aims to evaluate HRQoL and health preference of diabetic patients with different diabetic complications in Chinese population. Methods A cross-sectional study was conducted in 1275 patients with DM, including 518 subjects with various DM-related complications. HRQoL and health preference were estimated using SF-12 and SF-6D questionnaires, respectively. Disease status of DM and complications were identified from documented clinical diagnosis. Multivariable regression was used to investigate the effects of specific complications on HRQoL and health preference, adjusting for socio-demographic and clinical parameters. Results The presence of any diabetic complication was associated with lower physical component summary (−3.81 points, P < 0.01), and end-stage renal disease (ESRD) showed greatest reduction (−7.05 points, P < 0.01). Mental component summary and mental health (MH) scores were not decreased in any of the diabetic complications. The health preference score for diabetic subjects without complications was 0.882 (95% CI, 0.778 to 0.989). The reductions of health preference score were significant for stroke (−0.042, 95% CI -0.072 to −0.012), ESRD (−0.055, 95% CI -0.093 to −0.017), and sight-threatening diabetic retinopathy (STDR) (−0.043, 95% CI -0.075 to −0.010), while heart disease had an insignificant reduction (−0.017, 95% CI -0.042 to 0.008). Conclusions The presence of any of the four major diabetic complications (heart disease, stroke, ESRD and STDR) was associated with lower HRQoL and health preference scores. Findings of this study facilitated the cost-effectiveness studies of alternative management strategies for prevention of diabetic complications in Chinese population. Electronic supplementary material The online version of this article (doi:10.1186/s12955-017-0699-4) contains supplementary material, which is available to authorized users.
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Yepes-Nuñez JJ, Zhang Y, Xie F, Alonso-Coello P, Selva A, Schünemann H, Guyatt G. Forty-two systematic reviews generated 23 items for assessing the risk of bias in values and preferences' studies. J Clin Epidemiol 2017; 85:21-31. [DOI: 10.1016/j.jclinepi.2017.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/23/2017] [Accepted: 04/14/2017] [Indexed: 11/29/2022]
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Bahia L, Kupfer R, Momesso D, Cabral DAP, Tschiedel B, Puñales M, Lavigne S, Façanha CFS, Forti AC, Mendes ADN, Tura BR. Health-related quality of life and utility values associated to hypoglycemia in patients with type 1 diabetes mellitus treated in the Brazilian Public Health System: a multicenter study. Diabetol Metab Syndr 2017; 9:9. [PMID: 28149328 PMCID: PMC5273819 DOI: 10.1186/s13098-017-0206-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/13/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hypoglycemia is a critical and limiting factor of a good metabolic control and can adversely affect the quality of life of diabetic patients. The aim of the study was to evaluate the health-related quality of life and calculate utilities values associated with hypoglycemia in patients with type 1 diabetes mellitus (T1DM). METHODS A multicenter, cross-sectional and observational study with T1DM patients from reference centers of the Brazilian public health system was conducted in three cities. Demographic and clinical data were collected, besides details on the frequency and severity of hypoglycemia. Health-related quality of life was assessed using EQ-5D instrument and utility values generated. RESULTS 221 patients (107 women, 114 men), aged 29.8 ± 11.6 and disease duration of 14.2 ± 9.1 years were included. Most patients (n = 214, 96.8%) reported at least one symptomatic hypoglycemia in the last three months, 68% (n = 150) reported nocturnal episodes and 34.8% (n = 77) reported severe episodes. High frequency (daily or weekly) was observed in 38.6 and 26% of those reporting nocturnal or severe hypoglycemia, respectively. The median visual analog scale was 70 [60-85] for all patients, with differences between those with and without severe hypoglycemia (70 [60-80] vs 80 [61-90]; p = 0.006) and those with high and low frequency (62.5 [50-72.25] vs 70 [60-80]; p = 0.007). The median utility values was 0.801 [0.756-1.000] for all patients, with difference between those with high and low frequency of severe episodes (0.737 [0.628-1.000] vs 0.801 [0.756-1.000]; p = 0.02). CONCLUSIONS This study shows the high frequency of hypoglycemia in a sample of T1DM patients treated in three reference centers of the Brazilian public health system and the impact of severe episodes on health-related quality of life. Utility values were generated and can be used in economic analysis for treatments that could decrease hypoglycemia and consequently improve quality of life.
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Affiliation(s)
- Luciana Bahia
- Universidade do Estado do Rio de Janeiro-UERJ, Rio de Janeiro, Brazil
- Visconde de Pirajá 547/501 Ipanema, Rio de Janeiro, 22410-003 Brazil
| | - Rosane Kupfer
- Instituto de Diabetes e Endocrinologia Luiz Capriglione-IEDE, Rio de Janeiro, Brazil
| | - Denise Momesso
- Instituto de Diabetes e Endocrinologia Luiz Capriglione-IEDE, Rio de Janeiro, Brazil
| | - Debora A. P. Cabral
- Instituto de Diabetes e Endocrinologia Luiz Capriglione-IEDE, Rio de Janeiro, Brazil
| | - Balduino Tschiedel
- Instituto da Criança com Diabetes do Rio Grande do Sul-ICDRS, Rio Grande do Sul, Brazil
| | - Marcia Puñales
- Instituto da Criança com Diabetes do Rio Grande do Sul-ICDRS, Rio Grande do Sul, Brazil
| | - Suzana Lavigne
- Instituto da Criança com Diabetes do Rio Grande do Sul-ICDRS, Rio Grande do Sul, Brazil
| | | | - Adriana C. Forti
- Centro de Diabetes e Hipertensão de Fortaleza-CIDH, Fortaleza, Brazil
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Predictors of Health-Related Quality of Life in Patients with Co-Morbid Diabetes and Chronic Kidney Disease. PLoS One 2016; 11:e0168491. [PMID: 27992595 PMCID: PMC5167387 DOI: 10.1371/journal.pone.0168491] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 12/01/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND People living with diabetes and chronic kidney disease (CKD) experience compromised quality of life. Consequently, it is critical to identify and understand factors influencing their health-related quality of life (HRQoL). This study examined factors associated with HRQoL among patients with diabetes and CKD. METHODS A cross sectional study among adults with comorbid diabetes and CKD (eGFR <60 mL/min/1.73m2) recruited from renal and diabetes clinics of four large tertiary referral hospitals in Australia was performed. Each participant completed the Kidney Disease Quality of Life (KDQoL ™ -36) questionnaire, which is comprised of two composite measures of physical and mental health and 3 kidney disease specific subscales with possible scores ranging from 0 to 100 with higher values indicating better HRQoL. Demographic and clinical data were also collected. Regression analyses were performed to determine the relationship between HRQoL and potential predictor factors. RESULTS A total of 308 patients were studied with a mean age of 66.9 (SD = 11.0) years and 70% were males. Mean scores for the physical composite summary, mental composite summary, symptom/problem list, effects of kidney disease and burden of kidney disease scales were 35.2, 47.0, 73.8, 72.5 and 59.8 respectively. Younger age was associated with lower scores in all subscales except for the physical composite summary. Female gender, obese or normal weight rather than overweight, and smoking were all associated with lower scores in one or more subscales. Scores were progressively lower with more advanced stage of CKD (p<0.05) in all subscales except for the mental composite summary. CONCLUSION In patients with diabetes and CKD, younger age was associated with lower scores in all HRQoL subscales except the physical composite summary and female gender, obese or normal weight and more advanced stages of CKD were associated with lower scores in one or more subscales. Identifying these factors will inform the timely implementation of interventions to improve the quality of life of these patients.
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McEwan P, Bennett H, Fellows J, Priaulx J, Bergenheim K. The Health Economic Value of Changes in Glycaemic Control, Weight and Rates of Hypoglycaemia in Type 1 Diabetes Mellitus. PLoS One 2016; 11:e0162441. [PMID: 27632534 PMCID: PMC5025276 DOI: 10.1371/journal.pone.0162441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/23/2016] [Indexed: 11/18/2022] Open
Abstract
AIMS Therapy-related consequences of treatment for type 1 diabetes mellitus (T1DM), such as weight gain and hypoglycaemia, act as a barrier to attaining optimal glycaemic control, indirectly influencing the incidence of vascular complications and associated morbidity and mortality. This study quantifies the individual and combined contribution of changes in hypoglycaemia frequency, weight and HbA1c to predicted quality-adjusted life-years (QALYs) within a T1DM population. MATERIALS AND METHODS We describe the Cardiff Type 1 Diabetes (CT1DM) Model, originally informed by the Diabetes Control and Complications Trial (DCCT) and updated with the Epidemiology of Diabetes Interventions and Complications (EDIC) study and Swedish National Diabetes Registry for microvascular and cardiovascular complications respectively. We report model validation results and the QALY impact of HbA1c, weight and hypoglycaemia changes. RESULTS Validation results demonstrated coefficients of determination for clinical endpoints of R2 = 0.863 (internal R2 = 0.999; external R2 = 0.823), costs R2 = 0.980 and QALYs R2 = 0.951. Achieving and maintaining a 1% HbA1c reduction was estimated to provide 0.61 additional discounted QALYs. Weight changes of ±1kg, ±2kg or ±3kg led to discounted QALY changes of ±0.03, ±0.07 and ±0.10 respectively, while modifying hypoglycaemia frequency by -10%, -20% or -30% resulted in changes of -0.05, -0.11 and -0.17. The differences in discounted costs, life-years and QALYs associated with HbA1c 6% versus 10% were -£19,037, 2.49 and 2.35 respectively. CONCLUSIONS Using a model updated with contemporary epidemiological data, this study presents an outcome-focused perspective to assessing the health economic consequences of differing levels of glycaemic control in T1DM with and without weight and hypoglycaemia effects.
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Affiliation(s)
- Phil McEwan
- Health Economics and Outcomes Research Ltd., Mulberry Drive, Cardiff, United Kingdom
| | - Hayley Bennett
- Health Economics and Outcomes Research Ltd., Mulberry Drive, Cardiff, United Kingdom
| | - Jonathan Fellows
- Health Economics and Outcomes Research Ltd., Mulberry Drive, Cardiff, United Kingdom
| | - Jennifer Priaulx
- Global Health Economics and Outcomes Research, AstraZeneca, London, United Kingdom
| | - Klas Bergenheim
- Global Health Economics and Outcomes Research, AstraZeneca, Molndal, Sweden
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Paracha N, Thuresson PO, Moreno SG, MacGilchrist KS. Health state utility values in locally advanced and metastatic breast cancer by treatment line: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2016; 16:549-559. [PMID: 27574879 DOI: 10.1080/14737167.2016.1222907] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION For patients with late-stage (metastatic) breast cancer, the impact of treatment on health-related quality of life is a key factor in decision-making. A systematic review was conducted to identify health state utility values (HSUVs) for late-stage breast cancer, derived using methods preferred by health technology assessment (HTA) agencies, by treatment line. The aim was to generate a list of HSUVs, that could help to justify the values used to populate cost-utility models. Areas covered: Ten electronic databases, international congress websites and online HSUV databases were searched (January 1995-May 2014) for HSUVs for adults with late-stage breast cancer that had been derived from methods favoured by HTA agencies. Publications were included only if they reported studies that originated HSUVs. Expert commentary: Large numbers of HSUVs are available for late-stage breast cancer in the published literature. Contrary to expectations, the HSUVs reported in the literature vary greatly for some health states. As a result, the choice of HSUV can have considerable implications for the outcomes of economic evaluations. Standardization of HSUV methodology is expected to reduce variability; however, further research is recommended for assessing the sensitivity of generic preference-based measures in late-stage (metastatic) breast cancer.
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Affiliation(s)
- Noman Paracha
- a F Hoffmann-La Roche AG , MORSE Health Technology Assessment Group , Basel , Switzerland
| | - Per-Olof Thuresson
- a F Hoffmann-La Roche AG , MORSE Health Technology Assessment Group , Basel , Switzerland
| | - Santiago G Moreno
- b Novartis Pharma AG , Market Access Oncology Region Europe , Basel , Switzerland
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Moayeri F, Hsueh YSA, Clarke P, Dunt D. Do Model-Based Studies in Chronic Obstructive Pulmonary Disease Measure Correct Values of Utility? A Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:363-73. [PMID: 27325328 DOI: 10.1016/j.jval.2016.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 12/29/2015] [Accepted: 01/30/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease that has considerable impact on utility-based health-related quality of life. Utility is a key input of many decision analytic models used for economic evaluations. OBJECTIVE To systematically review COPD-related utilities and to compare these with alternative values used in decision models. METHODS The literature review comprised studies that generated utilities for COPD-related stages based on EuroQol five-dimensional questionnaire surveys of patients and of decision models of COPD progression that have been used for economic evaluations. The utility values used in modeling studies and those from the meta-analysis of actual patient-level studies were compared and differences quantified. RESULTS Twenty decision modeling studies that used utility value as an input parameter were found. Within the same span of publication period, 13 studies involving patient-level utility data were identified and included in the meta-analysis. The estimated mean utility values ranged from 0.806 (95% confidence interval [CI] 0.747-0.866) for stage I to 0.616 (95% CI 0.556-0.676) for stage IV. The utility scores for comparable stages in modeling studies were different (significant difference 0.045 [95% CI 0.041-0.052] for stage III). Modeling studies consistently used higher utility values than the average reported patient-level data. CONCLUSIONS COPD decision analytic models are based on a limited range of utility values that are systematically different from average values estimated using a meta-analysis. A more systematic approach in the application of utility measures in economic evaluation is required to appropriately reflect current literature.
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Affiliation(s)
- Foruhar Moayeri
- Centre for Health Policy, Melbourne, School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.
| | - Ya-Seng Arthur Hsueh
- Centre for Health Policy, Melbourne, School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Philip Clarke
- Centre for Health Policy, Melbourne, School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne, School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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de Graaff B, Neil A, Sanderson K, Yee KC, Palmer AJ. Quality of life utility values for hereditary haemochromatosis in Australia. Health Qual Life Outcomes 2016; 14:31. [PMID: 26922941 PMCID: PMC4770680 DOI: 10.1186/s12955-016-0431-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 02/12/2016] [Indexed: 01/26/2023] Open
Abstract
Background Hereditary hemochromatosis (HH) is a common autosomal recessive disorder amongst persons of northern European heritage. If untreated, iron accumulates in parenchymal tissues causing morbidity and mortality. As diagnosis often follows irreversible organ damage, screening programs have been suggested to increase early diagnosis. A lack of economic evidence has been cited as a barrier to establishing such a program. Previous analyses used poorly estimated utility values. This study sought to measure utilities directly from people with HH in Australia. Methods Volunteers with HH were recruited to complete a web-based survey. Utility was assessed using the Assessment of Quality of Life 4D (AQOL-4D) instrument. Severity of HH was graded into four categories. Multivariable regression analysis was performed to identify parameters associated with HSUV. Results Between November 2013 and November 2014, 221 people completed the survey. Increasing severity of HH was negatively associated with utility. Mean (standard deviation) utilities were 0.76 (0.21), 0.81 (0.18), 0.60 (0.27), and 0.50 (0.27) for categories 1–4 HH respectively. Lower mean utility was found for symptomatic participants (categories 3 and 4) compared with asymptomatic participants (0.583 v. 0.796). Self-reported HH-related symptoms were negatively associated with HSUV (r = −0.685). Conclusions Symptomatic stages of HH and presence of multiple self-reported symptoms were associated with decreasing utility. Previous economic analyses have used higher utilities which likely resulted in underestimates of the cost effectiveness of HH interventions. The utilities reported in this paper are the most robust available, and will contribute to improving the validity of future economic models for HH.
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Affiliation(s)
- Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences Building 1, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Amanda Neil
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences Building 1, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Kristy Sanderson
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences Building 1, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Kwang Chien Yee
- School of Medicine, University of Tasmania, Medical Sciences Building 2, 17 Liverpool St, Private Bag 68, Hobart, TAS, 7000, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences Building 1, 17 Liverpool St, Private Bag 23, Hobart, TAS, 7000, Australia.
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Hayes A, Arima H, Woodward M, Chalmers J, Poulter N, Hamet P, Clarke P. Changes in Quality of Life Associated with Complications of Diabetes: Results from the ADVANCE Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:36-41. [PMID: 26797234 DOI: 10.1016/j.jval.2015.10.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 10/11/2015] [Accepted: 10/18/2015] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To measure the impact of complications on summary measures of health-related quality of life among people with type 2 diabetes. METHODS Patients participating in the Action in Diabetes and Vascular Disease:Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial were administered a health-related quality-of-life questionnaire, the three-level EuroQol five-dimensional questionnaire (EQ-5D-3L), on four occasions over a 5-year period. We used two-way fixed-effects longitudinal regression models to investigate the impact of incident diabetes complications (stroke, heart failure, myocardial infarction, ischemic heart disease, renal failure, blindness, and amputation) on EQ-5D-3L utility score (where 1 = perfect health), while controlling for characteristics of individuals that do not vary over time. RESULTS The effect of having any one of the seven complications was to reduce the EQ-5D-3L utility score by 0.054 (95% confidence interval 0.044-0.064), and this was not significantly affected by baseline age, sex, economic region, or the value set used to derive utilities. The complication with the largest disutility was amputation (0.122), followed by stroke (0.099), blindness (0.083), renal failure (0.049), heart failure (0.045), and myocardial infarction (0.026). Ischemic heart disease did not significantly reduce the utility score. Quality of life also declined with elapsed time-by an average of 0.006 per year, in addition to the effect of complications. CONCLUSIONS Common complications significantly reduce health-related quality of life. Utility scores derived from the EQ-5D-3L provide a potential measure that can be used to summarize patient-reported outcomes and inform health economic models. Prevention of complications is critical to reduce the progressive burden of declining quality of life for people with diabetes.
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Affiliation(s)
- Alison Hayes
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Hisatomi Arima
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Mark Woodward
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John Chalmers
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Neil Poulter
- Imperial College and St. Mary's Hospital, London, UK
| | - Pavel Hamet
- Montreal Diabetes Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Philip Clarke
- School of Population and Global health, University of Melbourne, Melbourne, Victoria, Australia
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Moayeri F, Hsueh YSA, Clarke P, Hua X, Dunt D. Health State Utility Value in Chronic Obstructive Pulmonary Disease (COPD); The Challenge of Heterogeneity: A Systematic Review and Meta-Analysis. COPD 2015; 13:380-98. [PMID: 26678545 DOI: 10.3109/15412555.2015.1092953] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) has a considerable impact on quality of life and well-being of patients. Health state utility value (HSUV) is a recognized measure for health economic appraisals and is extensively used as an indicator for decision-making studies. This study is a systematic review of literature aimed to estimate mean utility value in COPD using meta-analysis and explore degree of heterogeneity in the utility values across a variety of clinical and study characteristic. The literature review covers studies that used EQ-5D to estimate utility value for patient level research in COPD. Studies that reported utility values elicited by EQ-5D in COPD patients were selected for random-effect meta-analysis addressing inter-study heterogeneity and subgroup analyses. Thirty-two studies were included in the general utility meta-analysis. The estimated general utility value was 0.673 (95% CI 0.653 to 0.693). Meta-analyses of COPD stages utility values showed influence of airway obstruction on utility value. The utility values ranged from 0.820 (95% CI 0.767 to 0.872) for stage I to 0.624 (95% CI 0.571 to 0.677) for stage IV. There was substantial heterogeneity in utility values: I(2) = 97.7%. A more accurate measurement of utility values in COPD is needed to refine valid and generalizable scores of HSUV. Given the limited success of the factors studied to reduce heterogeneity, an approach needs to be developed how best to use mean utility values for COPD in health economic evaluation.
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Affiliation(s)
- Foruhar Moayeri
- a Centre for Health Policy School of Population and Global Health , The University of Melbourne , Melbourne , Australia
| | - Ya-Seng Arthur Hsueh
- a Centre for Health Policy School of Population and Global Health , The University of Melbourne , Melbourne , Australia
| | - Philip Clarke
- a Centre for Health Policy School of Population and Global Health , The University of Melbourne , Melbourne , Australia
| | - Xinyang Hua
- a Centre for Health Policy School of Population and Global Health , The University of Melbourne , Melbourne , Australia
| | - David Dunt
- a Centre for Health Policy School of Population and Global Health , The University of Melbourne , Melbourne , Australia
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Peasgood T, Brazier J. Is Meta-Analysis for Utility Values Appropriate Given the Potential Impact Different Elicitation Methods Have on Values? PHARMACOECONOMICS 2015; 33:1101-5. [PMID: 26133293 PMCID: PMC4607715 DOI: 10.1007/s40273-015-0310-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
A growing number of published articles report estimates from meta-analysis or meta-regression on health state utility values (HSUVs), with a view to providing input into decision-analytic models. Pooling HSUVs is problematic because of the fact that different valuation methods and different preference-based measures (PBMs) can generate different values on exactly the same clinical health state. Existing meta-analyses of HSUVs are characterised by high levels of heterogeneity, and meta-regressions have identified significant (and substantial) impacts arising from the elicitation method used. The use of meta-regression with few utility values and inclusion criteria that extend beyond the required utility value has not helped. There is the potential to explore greater use of mapping between different PBMs and valuation methods prior to data synthesis, which could support greater use of pooling values. Researchers wishing to populate decision-analytic models have a responsibility to incorporate all high-quality evidence available. In relation to HSUVs, greater understanding of the differences between different methods and greater consistency of methodology is required before this can be achieved.
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Affiliation(s)
- Tessa Peasgood
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA, UK.
| | - John Brazier
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA, UK
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de Graaff B, Neil A, Sanderson K, Si L, Yee KC, Palmer AJ. A Systematic Review and Narrative Synthesis of Health Economic Studies Conducted for Hereditary Haemochromatosis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:469-483. [PMID: 26255179 DOI: 10.1007/s40258-015-0189-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Hereditary haemochromatosis (HH) is a common genetic condition amongst people of northern European heritage. HH is associated with increased iron absorption leading to parenchymal organ damage and multiple arthropathies. Early diagnosis and treatment prevents complications. Population screening may increase early diagnosis, but no programmes have been introduced internationally: a paucity of health economic data is often cited as a barrier. OBJECTIVE To conduct a systematic review of all health economic studies in HH. METHODS Studies were identified through electronic searching of economic/biomedical databases. Any study on HH with original economic component was included. Study quality was formally assessed. Health economic data were extracted and analysed through narrative synthesis. RESULTS Thirty-eight studies met the inclusion criteria. The majority of papers reported on costs or cost effectiveness of screening programmes. Whilst most concluded screening was cost effective compared with no screening, methodological flaws limit the quality of these findings. Assumptions regarding clinical penetrance, effectiveness of screening, health-state utility values (HSUVs), exclusion of early symptomatology (such as fatigue, lethargy and multiple arthropathies) and quantification of costs associated with HH were identified as key limitations. Treatment studies concluded therapeutic venepuncture was the most cost-effective intervention. CONCLUSIONS There is a paucity of high-quality health economic studies relating to HH. The development of a comprehensive HH cost-effectiveness model utilising HSUVs is required to determine whether screening is worthwhile.
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Affiliation(s)
- Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia
| | - Amanda Neil
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia
| | - Kristy Sanderson
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia
| | - Kwang Chien Yee
- School of Medicine, University of Tasmania, Medical Science 1 Building, 17 Liverpool St, Private Bag 68, Hobart, TAS, 7000, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia.
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Sampson CJ, Tosh JC, Cheyne CP, Broadbent D, James M. Health state utility values for diabetic retinopathy: protocol for a systematic review and meta-analysis. Syst Rev 2015; 4:15. [PMID: 25875206 PMCID: PMC4342097 DOI: 10.1186/s13643-015-0006-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/22/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND People with diabetic retinopathy tend to have lower levels of health-related quality of life than individuals with no retinopathy. Strategies for screening and treatment have been shown to be cost-effective. In order to reduce the bias in cost-effectiveness estimates, systematic reviews of health state utility values (HSUVs) are crucial for health technology assessment and the development of decision analytic models. A review and synthesis of HSUVs for the different stages of disease progression in diabetic retinopathy has not previously been conducted. METHODS/DESIGN We will conduct a systematic review of the available literature that reports HSUVs for people with diabetic retinopathy, in correspondence with current stage of disease progression and/or visual acuity. We will search Medline, EMBASE, Web of Science, Cost-Effectiveness Analysis Registry, Centre for Reviews and Dissemination Database, and EconLit to identify relevant English-language articles. Data will subsequently be synthesized using linear mixed effects modeling meta-regression. Additionally, reported disease severity classifications will be mapped to a four-level grading scale for diabetic retinopathy. DISCUSSION The systematic review and meta-analysis will provide important evidence for future model-based economic evaluations of technologies for diabetic retinopathy. The meta-regression will enable the estimation of utility values at different disease stages for patients with particular characteristics and will also highlight where the design of the study and HSUV instrument have influenced the reported utility values. We believe this protocol to be the first of its kind to be published. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014012891.
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Affiliation(s)
- Christopher J Sampson
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - Jonathan C Tosh
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield, S1 4DA, UK.
| | - Christopher P Cheyne
- Department of Biostatistics, University of Liverpool, Daulby Street, Liverpool, L69 3GA, UK.
| | - Deborah Broadbent
- Department of Eye and Vision Science, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
| | - Marilyn James
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
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Huang CY, Lai HL, Lu YC, Chen WK, Chi SC, Lu CY, Chen CI. Risk Factors and Coping Style Affect Health Outcomes in Adults With Type 2 Diabetes. Biol Res Nurs 2015; 18:82-9. [PMID: 25670841 DOI: 10.1177/1099800415569845] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Most psychosocial interventions among individuals with Type 2 diabetes mellitus (T2DM) target depressive symptoms (DSs) rather than causal antecedents that lead to DSs or affect health-related quality of life (HrQoL). This research investigated a conceptual model of the effects of risk factors and coping styles on HrQoL and DSs in patients with T2DM. METHOD A descriptive, correlational design was used with a convenience sample of 241 adults with T2DM aged ≥ 20 years recruited from a hospital metabolic outpatient department. Data were collected using a demographic questionnaire, the modified Ways of Coping Checklist, the Center for Epidemiological Studies Depression Scale, the Short Form 36 Health Survey, and physiological examination. HbA1C was collected from participants' medical records. Structural equation modeling techniques were used to analyze relationships among risk factors, mediators, and HrQoL. RESULTS Younger age, more education, and longer duration of diabetes predicted better physical quality of life. Duration of diabetes and three coping styles predicted DSs. Longer duration of diabetes and lower fasting glucose predicted better mental quality of life. Three coping styles acted as mediators between risk factors and health, that is, active and minimizing styles promoted positive outcomes, while avoidance promoted negative outcomes. CONCLUSIONS This integrated model provides a holistic picture of how risk factors and coping style influence HrQoL and DSs in individuals with T2DM. Nurses could use active coping strategies in cognitive behavioral therapy to enhance glycemic control in patients with T2DM.
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Affiliation(s)
| | - Hui-Ling Lai
- Department of Nursing, Tzu Chi University, Hualien, Taiwan Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Yung-Chuan Lu
- Department of Endocrinology, E-Da Hospital, Kaohsiung, Taiwan I-Shou University, Kaohsiung, Taiwan
| | - Wen-Kuei Chen
- College of Management, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Ching Chi
- I-Shou University, Kaohsiung, Taiwan Department of Nursing, E-Da Hospital, Kaohsiung, Taiwan
| | - Chu-Yun Lu
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - Chun-I Chen
- College of Management, I-Shou University, Kaohsiung, Taiwan
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Abstract
OBJECTIVE To summarize the published literature on utilities for health states associated with diabetic kidney disease (DKD), including end-stage renal disease (ESRD). RESEARCH DESIGN AND METHODS A literature review was conducted (MEDLINE, MEDLINE in process, EMBASE, NHS EED, HEED, CEA Registry, EconLit, RePEc, and HTA) to identify relevant articles published between January 2000 and July 2013. Results were assessed for relevance by two reviewers in line with the study protocol. MAIN OUTCOME MEASURES For eligible studies, data extracted included patient population, health states, methods used to elicit utility values, and the source of the preference values. RESULTS Twelve studies satisfied the inclusion criteria. They reported various utility and/or disutility scores for different DKD health states using a range of patient populations, utility approaches, and sources of preference values. The most common study country was the USA. Most of the studies collected data at one time point, but two had a longitudinal design. Three different utility instruments - EuroQoL (EQ-5D), Quality of Well-Being Scale (QWB), and 15-dimensional (15D) - were used to elicit utilities indirectly. The Time Trade-Off (TTO) approach was used in one study; another undertook a meta-analysis of published utility studies. Utilities were identified for different health states including DKD, ESRD-no dialysis, ESRD-dialysis, and transplant. One study reported utilities for patients by type of transplant. There was variation in values for the same health state between studies, and none of the studies reported utilities for the different stages of DKD. In the studies that undertook a comparison, utility values for those with DKD were generally found to be lower than those without DKD. CONCLUSIONS This literature review highlights that at present utility scores (or disutility penalties) exist for relatively few health states in DKD. Further studies are needed to produce accurate and comprehensive utility scores that differentiate between different DKD health states.
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Beaudet A, Clegg J, Thuresson PO, Lloyd A, McEwan P. Review of utility values for economic modeling in type 2 diabetes. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:462-70. [PMID: 24969008 DOI: 10.1016/j.jval.2014.03.003] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 03/05/2014] [Accepted: 03/11/2014] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Economic analysis in type 2 diabetes mellitus (T2DM) requires an assessment of the effect of a wide range of complications. The objective of this article was to identify a set of utility values consistent with the National Institute for Health and Care Excellence (NICE) reference case and to critically discuss and illustrate challenges in creating such a utility set. METHODS A systematic literature review was conducted to identify studies reporting utility values for relevant complications. The methodology of each study was assessed for consistency with the NICE reference case. A suggested set of utility values applicable to modeling was derived, giving preference to studies reporting multiple complications and correcting for comorbidity. RESULTS The review considered 21 relevant diabetes complications. A total of 16,574 articles were identified; after screening, 61 articles were assessed for methodological quality. Nineteen articles met NICE criteria, reporting utility values for 20 of 21 relevant complications. For renal transplant, because no articles meeting NICE criteria were identified, two articles using other methodologies were included. Index value estimates for T2DM without complication ranged from 0.711 to 0.940. Utility decrement associated with complications ranged from 0.014 (minor hypoglycemia) to 0.28 (amputation). Limitations associated with the selection of a utility value for use in economic modeling included variability in patient recruitment, heterogeneity in statistical analysis, large variability around some point estimates, and lack of recent data. CONCLUSIONS A reference set of utility values for T2DM and its complications in line with NICE requirements was identified. This research illustrates the challenges associated with systematically selecting utility data for economic evaluations.
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Affiliation(s)
| | | | | | | | - Phil McEwan
- Centre for Health Economics, Swansea University, Swansea, UK
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Alva M, Gray A, Mihaylova B, Clarke P. The effect of diabetes complications on health-related quality of life: the importance of longitudinal data to address patient heterogeneity. HEALTH ECONOMICS 2014; 23:487-500. [PMID: 23847044 DOI: 10.1002/hec.2930] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 03/06/2013] [Accepted: 03/19/2013] [Indexed: 06/02/2023]
Abstract
We estimate the impact of six diabetes-related complications (myocardial infarction, ischaemic heart disease, stroke, heart failure, amputation and visual acuity) on quality of life, using seven rounds of EQ-5D questionnaires administered between 1997 and 2007 in the UK Prospective Diabetes Study. The use of cross-sectional data to make such estimates is widespread in the literature, being less expensive and easier to collect than repeated-measures data. However, analysis of this dataset suggests that cross-sectional analysis could produce biased estimates of the effect of complications on QoL. Using fixed effects estimators, we show that variation in the quality of life between patients is strongly influenced by time-invariant patient characteristics. Our results highlight the importance of studying quality-of-life changes over time to distinguish between time-invariant determinants of QoL and the effect on QoL of specific events such as diabetes complications.
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Affiliation(s)
- Maria Alva
- HERC, Department of Public Health, University of Oxford, Oxford, UK
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de Vries FM, Denig P, Visser ST, Hak E, Postma MJ. Cost-effectiveness of statins for primary prevention in patients newly diagnosed with type 2 diabetes in the Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:223-230. [PMID: 24636380 DOI: 10.1016/j.jval.2013.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 11/14/2013] [Accepted: 12/20/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Statins are lipid-lowering drugs that reduce the risk of cardiovascular events in patients with diabetes. OBJECTIVES The objective of this study was to determine whether statin treatment for primary prevention in newly diagnosed type 2 diabetes is cost-effective, taking nonadherence, baseline risk, and age into account. METHODS A cost-effectiveness analysis was performed by using a Markov model with a time horizon of 10 years. The baseline 10-year cardiovascular risk was estimated in a Dutch population of primary prevention patients with newly diagnosed diabetes from the Groningen Initiative to Analyse Type 2 Diabetes Treatment (GIANTT) database, using the United Kingdom Prospective Diabetes Study risk engine. Statin adherence was measured as pill days covered in the IADB.nl pharmacy research database. Cost-effectiveness was measured in costs per quality-adjusted life-year (QALY) from the health care payers' perspective. RESULTS For an average patient aged 60 years, the base case, statin treatment was highly cost-effective at €2245 per QALY. Favorable cost-effectiveness was robust in sensitivity analysis. Differences in age and 10-year cardiovascular risk showed large differences in cost-effectiveness from almost €100,000 per QALY to almost being cost saving. Treating all patients younger than 45 years at diabetes diagnosis was not cost-effective (weighted cost-effectiveness of almost €60,000 per QALY). CONCLUSIONS Despite the nonadherence levels observed in actual practice, statin treatment is cost-effective for primary prevention in patients newly diagnosed with type 2 diabetes. Because of large differences in cost-effectiveness according to different risk and age groups, the efficiency of the treatment could be increased by targeting patients with relatively higher cardiovascular risk and higher ages.
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Affiliation(s)
- Folgerdiena M de Vries
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands.
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sipke T Visser
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands
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