Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK.
Diabet Med. 2014 Apr;31(4):477-86. doi: 10.1111/dme.12371. Epub 2014 Feb 5.
To build a flexible and comprehensive long-term type 1 diabetes mellitus model incorporating the most up-to-date methodologies to allow a number of cost-effectiveness evaluations.
This paper describes the conceptual modelling, model implementation and model validation of the Sheffield type 1 diabetes policy model (version 1.0), developed through funding by the U.K. National Institute for Health Research as part of the Dose Adjustment for Normal Eating research programme. The model is an individual patient-level simulation model of type 1 diabetes and it includes long-term microvascular (retinopathy, neuropathy and nephropathy) and macrovascular (myocardial infarction, stroke, revascularization and angina) diabetes-related complications and acute adverse events (severe hypoglycaemia and diabetic ketoacidosis). The occurrence of these diabetes-related complications in the model is linked to simulated individual patient-level risk factors, including HbA1c , age, duration of diabetes, lipids and blood pressure. Transition probabilities were modelled based on a combination of existing risk functions, published trials, epidemiological studies and individual-level data from the Dose Adjustment for Normal Eating research programme.
The model takes a lifetime perspective, estimating the impact of interventions on costs, clinical outcomes, survival and quality-adjusted life years. Validation of the model suggested that, for almost all diabetes-related complications predicted, event rates were within 10% of the normalized rates reported in the studies used to build the model.
The model is highly flexible and has broad potential application to evaluate the Dose Adjustment for Normal Eating research programme, other structured diabetes education programmes and other interventions for type 1 diabetes.
构建一个灵活全面的长期 1 型糖尿病模型，采用最新方法，以进行多项成本效益评估。
本文描述了谢菲尔德 1 型糖尿病政策模型（版本 1.0）的概念建模、模型实现和模型验证，该模型由英国国家卫生研究院资助，作为 Dose Adjustment for Normal Eating 研究计划的一部分。该模型是 1 型糖尿病的个体患者水平模拟模型，包括长期微血管（视网膜病变、神经病变和肾病）和大血管（心肌梗死、中风、血运重建和心绞痛）糖尿病相关并发症和急性不良事件（严重低血糖和糖尿病酮症酸中毒）。模型中这些糖尿病相关并发症的发生与模拟的个体患者水平风险因素相关，包括 HbA1c、年龄、糖尿病病程、血脂和血压。基于现有风险函数、已发表的试验、流行病学研究以及 Dose Adjustment for Normal Eating 研究计划中的个体数据，对转移概率进行建模。
该模型采用终身视角，估计干预对成本、临床结局、生存和质量调整生命年的影响。模型验证表明，对于预测的几乎所有糖尿病相关并发症，事件发生率与用于构建模型的研究中报告的归一化率相差在 10%以内。
该模型具有高度灵活性，具有广泛的潜在应用，可用于评估 Dose Adjustment for Normal Eating 研究计划、其他结构化糖尿病教育计划以及其他 1 型糖尿病干预措施。
