Sydney School of Public Health, University of Sydney, Edward Ford Building, Sydney, NSW 2006, Australia.
Qual Life Res. 2011 Dec;20(10):1669-78. doi: 10.1007/s11136-011-9902-y. Epub 2011 Apr 7.
To review published studies on the effect of diabetes and its complications on utility scores to establish whether there is systematic variation across studies and to examine the implications for the estimation of quality-adjusted life years (QALYs).
A systematic review was performed using studies reporting QALY measures elicited from people with diabetes including those with a history of complications. Meta-analysis was used to obtain the average utility, and meta-regression was employed to examine the impact of study characteristics and elicitation methods on these values. The effect of different utility scores on QALYs was examined using diabetes simulation models.
In the meta-analysis based on 45 studies reporting 66 values, the average utility score was 0.76 (95% CI 0.75-0.77). A meta-regression showed significant variation due to age, method of elicitation and the proportion of males. The average utility score for individual complications ranged from 0.48 (95% CI 0.25, 0.71) for chronic renal disease to 0.75 (95% CI 0.73, 0.78) for myocardial infarction, and these differences produced meaningful changes in simulated QALYs. There was significant heterogeneity between studies.
We provide summary utility scores for diabetes and its major complications that could help inform economic evaluation and policy analysis.
回顾关于糖尿病及其并发症对效用评分影响的已发表研究，以确定研究间是否存在系统差异，并探讨其对质量调整生命年（QALY）估计的影响。
采用系统评价方法，检索报告了从糖尿病患者（包括有并发症史的患者）中获得的 QALY 测量值的研究。Meta 分析用于获得平均效用，Meta 回归用于检验研究特征和 elicitation 方法对这些值的影响。使用糖尿病模拟模型检查不同效用评分对 QALY 的影响。
基于 45 项报告了 66 个值的研究的 Meta 分析，平均效用评分为 0.76（95%CI 0.75-0.77）。Meta 回归显示，年龄、elicitation 方法和男性比例的差异具有统计学意义。个别并发症的平均效用评分范围从慢性肾病的 0.48（95%CI 0.25，0.71）到心肌梗死的 0.75（95%CI 0.73，0.78），这些差异导致模拟 QALY 发生了有意义的变化。研究之间存在显著的异质性。
我们提供了糖尿病及其主要并发症的综合效用评分，有助于为经济评估和政策分析提供信息。
