Palmer Andrew J, Dinneen Sean, Gavin James R, Gray Alastair, Herman William H, Karter Andrew J
CORE - Center for Outcomes Research, a unit of IMS Health, Binningen, Switzerland.
Curr Med Res Opin. 2006 May;22(5):861-72. doi: 10.1185/030079906X104669.
Self-monitoring of blood glucose (SMBG) in type 2 diabetes patients has been shown in meta-analyses of randomized trials to improve HbA(1c) by approximately 0.4% when compared to no SMBG. However, the cost of testing supplies is high, improvements in health utility due to improved glycaemic control may be possible and cost-effectiveness has not been evaluated.
A peer-reviewed validated model projected improvements in lifetime quality-adjusted life years (QALYs), long-term costs and cost-effectiveness of SMBG versus no SMBG. Markov/Monte Carlo modelling simulated the progression of complications (cardiovascular, neuropathy, renal and eye disease). Transition probabilities and HbA(1c)-dependent adjustments came from the United Kingdom Prospective Diabetes Study (UKPDS) and other major studies. Effects of SMBG on HbA(1c) came from clinical studies, meta-analyses and population studies, but can only be considered 'moderate' levels of evidence. Costs of complications were retrieved from published sources. Direct costs of diabetes complications and SMBG were projected over patient lifetimes from a UK National Health Service perspective. Outcomes were discounted at 3.5% annually. Extensive sensitivity analyses were performed.
Depending on the type of diabetes treatment (diet and exercise/oral medications/insulin), improvements in glycaemic control with SMBG improved discounted QALYs anywhere from 0.165 to 0.255 years, with increased total costs of 1013 pounds sterlings- 2564 pounds sterlings/patient, giving incremental cost-effectiveness ratios of 4508 pounds sterlings: 15,515 pounds sterlings/QALY gained, well within current UK willingness-to-pay limits. Results were robust under a wide range of plausible assumptions.
Based on the moderate level of clinical evidence available to date, improvements in glycaemic control with interventions, including SMBG, can improve patient outcomes, with acceptable cost-effectiveness ratios in the UK setting.
在随机试验的荟萃分析中显示，与不进行自我血糖监测（SMBG）相比，2型糖尿病患者进行SMBG可使糖化血红蛋白（HbA1c）改善约0.4%。然而，检测用品成本高昂，血糖控制改善可能带来健康效用的提升，且成本效益尚未得到评估。
一个经过同行评审验证的模型预测了SMBG与不进行SMBG相比在终身质量调整生命年（QALY）、长期成本和成本效益方面的改善情况。马尔可夫/蒙特卡洛模型模拟了并发症（心血管疾病、神经病变、肾脏疾病和眼部疾病）的进展。转移概率和依赖于HbA1c的调整来自英国前瞻性糖尿病研究（UKPDS）和其他主要研究。SMBG对HbA1c的影响来自临床研究、荟萃分析和人群研究，但只能被视为“中等”水平的证据。并发症成本从已发表的资料中获取。从英国国家医疗服务体系的角度预测了糖尿病并发症和SMBG的直接成本在患者一生中的情况。结果按每年3.5%进行贴现。进行了广泛的敏感性分析。
根据糖尿病治疗类型（饮食和运动/口服药物/胰岛素），SMBG改善血糖控制可使贴现后的QALY增加0.165至0.255年，每位患者的总成本增加1013英镑至2564英镑，增量成本效益比为4508英镑至15515英镑/获得的QALY，完全在英国当前的支付意愿范围内。在广泛的合理假设下，结果是稳健的。
基于目前可得的中等水平临床证据，包括SMBG在内的干预措施改善血糖控制可改善患者预后，在英国背景下具有可接受的成本效益比。
