Clarke P M, Gray A M, Briggs A, Farmer A J, Fenn P, Stevens R J, Matthews D R, Stratton I M, Holman R R
Health Economics Research Centre, Department of Public Health, University of Oxford, Headington, Oxford, UK.
Diabetologia. 2004 Oct;47(10):1747-59. doi: 10.1007/s00125-004-1527-z. Epub 2004 Oct 27.
AIMS/HYPOTHESIS: The aim of this study was to develop a simulation model for type 2 diabetes that can be used to estimate the likely occurrence of major diabetes-related complications over a lifetime, in order to calculate health economic outcomes such as quality-adjusted life expectancy.
Equations for forecasting the occurrence of seven diabetes-related complications and death were estimated using data on 3642 patients from the United Kingdom Prospective Diabetes Study (UKPDS). After examining the internal validity, the UKPDS Outcomes Model was used to simulate the mean difference in expected quality-adjusted life years between the UKPDS regimens of intensive and conventional blood glucose control.
The model's forecasts fell within the 95% confidence interval for the occurrence of observed events during the UKPDS follow-up period. When the model was used to simulate event history over patients' lifetimes, those treated with a regimen of conventional glucose control could expect 16.35 undiscounted quality-adjusted life years, and those receiving treatment with intensive glucose control could expect 16.62 quality-adjusted life years, a difference of 0.27 (95% CI: -0.48 to 1.03).
CONCLUSIONS/INTERPRETATIONS: The UKPDS Outcomes Model is able to simulate event histories that closely match observed outcomes in the UKPDS and that can be extrapolated over patients' lifetimes. Its validity in estimating outcomes in other groups of patients, however, remains to be evaluated. The model allows simulation of a range of long-term outcomes, which should assist in informing future economic evaluations of interventions in type 2 diabetes.
目的/假设：本研究的目的是开发一种2型糖尿病模拟模型，该模型可用于估计一生当中主要糖尿病相关并发症的可能发生率，以便计算诸如质量调整预期寿命等健康经济指标。
利用英国前瞻性糖尿病研究（UKPDS）中3642例患者的数据，估算了预测7种糖尿病相关并发症及死亡发生率的方程。在检验内部有效性之后，使用UKPDS结局模型模拟UKPDS强化血糖控制方案与传统血糖控制方案之间预期质量调整生命年的平均差异。
在UKPDS随访期间，该模型的预测结果落在观察到的事件发生率的95%置信区间内。当使用该模型模拟患者一生的事件史时，接受传统血糖控制方案治疗的患者预期有16.35个未贴现的质量调整生命年，接受强化血糖控制治疗的患者预期有16.62个质量调整生命年，差异为0.27（95%CI：-0.48至1.03）。
结论/解读：UKPDS结局模型能够模拟与UKPDS中观察到的结局密切匹配且可外推至患者一生的事件史。然而，其在估计其他患者群体结局方面的有效性仍有待评估。该模型能够模拟一系列长期结局，这应有助于为未来2型糖尿病干预措施的经济评估提供信息。
