TY - JOUR AU - Clarke P. AU - Lung Thomas AU - Hua X. AU - Palmer A. AU - Si L. AU - Herman W. AB -

BACKGROUND: There are an increasing number of studies using simulation models to conduct cost-effectiveness analyses for type 2 diabetes mellitus. OBJECTIVE: To evaluate the relationship between improvements in glycosylated haemoglobin (HbA1c) and simulated health outcomes in type 2 diabetes cost-effectiveness studies. METHODS: A systematic review was conducted on MEDLINE and EMBASE to collect cost-effectiveness studies using type 2 diabetes simulation models that reported modelled health outcomes of blood glucose-related interventions in terms of quality-adjusted life-years (QALYs) or life expectancy (LE). The data extracted included information used to characterise the study cohort, the intervention's treatment effects on risk factors and model outcomes. Linear regressions were used to test the relationship between the difference in HbA1c (HbA1c) and incremental QALYs (QALYs) or LE (LE) of intervention and control groups. The ratio between the QALYs and LE was calculated and a scatterplot between the ratio and HbA1c was used to explore the relationship between these two. RESULTS: Seventy-six studies were included in this research, contributing to 124 pair of comparators. The pooled regressions indicated that the marginal effect of a 1% HbA1c decrease in intervention resulted in an increase in life-time QALYs and LE of 0.371 (95% confidence interval 0.286-0.456) and 0.642 (95% CI 0.494-0.790), respectively. No evidence of heterogeneity between models was found. An inverse exponential relationship was found and fitted between the ratio (QALY/LE) and HbA1c. CONCLUSION: There is a consistent relationship between HbA1c and QALYs or LE in cost-effectiveness analyses using type 2 diabetes simulation models. This relationship can be used as a diagnostic tool for decision makers.

AD - School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
The George Institute for Global Health, University of Sydney, Lidcombe, NSW, Australia.
Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia.
School of Public Health, University of Michigan, Ann Arbor, MI, USA.
School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia. philip.clarke@unimelb.edu.au. AN - 27873225 BT - Pharmacoeconomics C2 - PMC5306373 PhD scholarship: Melbourne International Research Scholarship from the University of Melbourne and some supplementary funding from two National Health and Medical Research Council project grants (GNT1084347; GNT1107140). No other funding has been received for the conduct of this study. Conflict of interest Philip Clarke has intellectual property in the UKPDS outcomes model and Andrew Palmer was involved in the development of the CORE diabetes model. Xinyang Hua, Thomas Lung, Lei Si and William Herman declare that they have no conflicts of interest. Author contributions Xinyang Hua designed the research, reviewed studies, extracted and analysed data, and drafted the manuscript. Thomas Lung designed the research and drafted the manuscript. Andrew Palmer designed the research and provided critical revision of the manuscript. Lei Si reviewed studies and extracted data. William Herman provided critical revision of the manuscript. Philip Clarke designed the research, supervised the study and helped review studies. DP - NLM ET - 2016/11/23 LA - eng M1 - 3 N1 - Hua, Xinyang
Lung, Thomas Wai-Chun
Palmer, Andrew
Si, Lei
Herman, William H
Clarke, Philip
P30 DK092926/DK/NIDDK NIH HHS/United States
Review
New Zealand
Pharmacoeconomics. 2017 Mar;35(3):319-329. doi: 10.1007/s40273-016-0466-0. N2 -

BACKGROUND: There are an increasing number of studies using simulation models to conduct cost-effectiveness analyses for type 2 diabetes mellitus. OBJECTIVE: To evaluate the relationship between improvements in glycosylated haemoglobin (HbA1c) and simulated health outcomes in type 2 diabetes cost-effectiveness studies. METHODS: A systematic review was conducted on MEDLINE and EMBASE to collect cost-effectiveness studies using type 2 diabetes simulation models that reported modelled health outcomes of blood glucose-related interventions in terms of quality-adjusted life-years (QALYs) or life expectancy (LE). The data extracted included information used to characterise the study cohort, the intervention's treatment effects on risk factors and model outcomes. Linear regressions were used to test the relationship between the difference in HbA1c (HbA1c) and incremental QALYs (QALYs) or LE (LE) of intervention and control groups. The ratio between the QALYs and LE was calculated and a scatterplot between the ratio and HbA1c was used to explore the relationship between these two. RESULTS: Seventy-six studies were included in this research, contributing to 124 pair of comparators. The pooled regressions indicated that the marginal effect of a 1% HbA1c decrease in intervention resulted in an increase in life-time QALYs and LE of 0.371 (95% confidence interval 0.286-0.456) and 0.642 (95% CI 0.494-0.790), respectively. No evidence of heterogeneity between models was found. An inverse exponential relationship was found and fitted between the ratio (QALY/LE) and HbA1c. CONCLUSION: There is a consistent relationship between HbA1c and QALYs or LE in cost-effectiveness analyses using type 2 diabetes simulation models. This relationship can be used as a diagnostic tool for decision makers.

PY - 2017 SN - 1179-2027 (Electronic)
1170-7690 (Linking) SP - 319 EP - 329 ST - PharmacoEconomics T2 - Pharmacoeconomics TI - How Consistent is the Relationship between Improved Glucose Control and Modelled Health Outcomes for People with Type 2 Diabetes Mellitus? a Systematic Review VL - 35 ER -