生活方式干预或二甲双胍在预防糖耐量受损成年人2型糖尿病方面的成本效益。
The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance.
作者信息
Herman William H, Hoerger Thomas J, Brandle Michael, Hicks Katherine, Sorensen Stephen, Zhang Ping, Hamman Richard F, Ackermann Ronald T, Engelgau Michael M, Ratner Robert E
机构信息
University of Michigan Health System, Ann Arbor, Michigan, USA.
出版信息
Ann Intern Med. 2005 Mar 1;142(5):323-32. doi: 10.7326/0003-4819-142-5-200503010-00007.
BACKGROUND
The Diabetes Prevention Program (DPP) demonstrated that interventions can delay or prevent the development of type 2 diabetes.
OBJECTIVE
To estimate the lifetime cost-utility of the DPP interventions.
DESIGN
Markov simulation model to estimate progression of disease, costs, and quality of life.
DATA SOURCES
The DPP and published reports.
TARGET POPULATION
Members of the DPP cohort 25 years of age or older with impaired glucose tolerance.
TIME HORIZON
Lifetime.
PERSPECTIVES
Health system and societal.
INTERVENTIONS
Intensive lifestyle, metformin, and placebo interventions as implemented in the DPP.
OUTCOME MEASURES
Cumulative incidence of diabetes, microvascular and neuropathic complications, cardiovascular complications, survival, direct medical and direct nonmedical costs, quality-adjusted life-years (QALYs), and cost per QALY.
RESULTS OF BASE-CASE ANALYSIS: Compared with the placebo intervention, the lifestyle and metformin interventions were estimated to delay the development of type 2 diabetes by 11 and 3 years, respectively, and to reduce the absolute incidence of diabetes by 20% and 8%, respectively. The cumulative incidence of microvascular, neuropathic, and cardiovascular complications were reduced and survival was improved by 0.5 and 0.2 years. Compared with the placebo intervention, the cost per QALY was approximately 1100 dollars for the lifestyle intervention and $31 300 for the metformin intervention. From a societal perspective, the interventions cost approximately 8800 dollars and 29,900 dollars per QALY, respectively. From both perspectives, the lifestyle intervention dominated the metformin intervention.
RESULTS OF SENSITIVITY ANALYSIS
Cost-effectiveness improved when the interventions were implemented as they might be in routine clinical practice. The lifestyle intervention was cost-effective in all age groups. The metformin intervention did not represent good use of resources for persons older than 65 years of age.
LIMITATIONS
Simulation results depend on the accuracy of the underlying assumptions, including participant adherence.
CONCLUSIONS
Health policy should promote diabetes prevention in high-risk individuals.
背景
糖尿病预防计划（DPP）表明，干预措施可以延缓或预防2型糖尿病的发生。
目的
评估DPP干预措施的终身成本效益。
设计
马尔可夫模拟模型，用于估计疾病进展、成本和生活质量。
数据来源
DPP及已发表的报告。
目标人群
DPP队列中年龄在25岁及以上且糖耐量受损的成员。
时间范围
终身。
视角
卫生系统和社会。
干预措施
DPP中实施的强化生活方式干预、二甲双胍干预和安慰剂干预。
结局指标
糖尿病累积发病率、微血管和神经病变并发症、心血管并发症、生存率、直接医疗和直接非医疗成本、质量调整生命年（QALY）以及每QALY成本。
基础病例分析结果
与安慰剂干预相比，生活方式干预和二甲双胍干预分别估计可将2型糖尿病的发生延迟11年和3年，并分别将糖尿病的绝对发病率降低20%和8%。微血管、神经病变和心血管并发症的累积发病率降低，生存率提高0.5年和0.2年。与安慰剂干预相比，生活方式干预的每QALY成本约为1100美元，二甲双胍干预为31300美元。从社会角度看，干预措施每QALY成本分别约为8800美元和29900美元。从两个角度看，生活方式干预均优于二甲双胍干预。
敏感性分析结果
当干预措施按常规临床实践可能的方式实施时，成本效益有所提高。生活方式干预在所有年龄组中均具有成本效益。二甲双胍干预对于65岁以上人群并非资源的良好利用方式。
局限性
模拟结果取决于基础假设的准确性，包括参与者的依从性。
结论
卫生政策应促进高危个体的糖尿病预防。
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