Health Economics Unit, Department of Clinical Sciences, Lund University, Lund 22381, Sweden.
Sahlgrenska University Hospital, Department of Medicine, University of Gothenburg, Gothenburg 41345, Sweden.
Int J Environ Res Public Health. 2014 May 7;11(5):4939-52. doi: 10.3390/ijerph110504939.
This study estimates health utilities (HU) in Sweden for a range of type 2 diabetes-related complications using EQ-5D and two alternative tariffs (UK and Swedish) from 1757 patients with type 2 diabetes from the Swedish National Diabetes Register (NDR). Ordinary least squares were used for statistical analysis. Lower HU was found for female gender, younger age at diagnosis, higher BMI, and history of complications. Microvascular and macrovascular complications had the most negative effect on HU among women and men, respectively. The greatest decline in HU was associated with kidney disorders (-0.114) using the UK tariff and stroke (-0.059) using the Swedish tariff. Multiple stroke and non-acute ischaemic heart disease had higher negative effect than a single event. With the UK tariff, each year elapsed since the last microvascular/macrovascular complication was associated with 0.013 and 0.007 units higher HU, respectively. We found important heterogeneities in effects of complications on HU in terms of gender, multiple event, and time. The Swedish tariff gave smaller estimates and so may result in less cost-effective interventions than the UK tariff. These results suggest that incorporating subgroup-specific HU in cost-utility analyses might provide more insight for informed decision-making.
本研究使用 EQ-5D 和两种替代关税(英国和瑞典),从瑞典国家糖尿病登记处(NDR)的 1757 名 2 型糖尿病患者中,估计了一系列 2 型糖尿病相关并发症的健康效用(HU)。采用最小二乘法进行统计分析。女性、诊断时年龄较小、BMI 较高和有并发症史的患者 HU 值较低。女性和男性的微血管和大血管并发症对 HU 的负面影响最大。使用英国关税,肾功能障碍(-0.114)和使用瑞典关税,中风(-0.059)与 HU 下降幅度最大有关。多次中风和非急性缺血性心脏病比单次事件的负面影响更大。使用英国关税,自上次微血管/大血管并发症以来,每年的时间流逝分别与 0.013 和 0.007 单位的 HU 增加相关。我们发现,并发症对 HU 的影响在性别、多重事件和时间方面存在重要的异质性。瑞典关税的估计值较小,因此与英国关税相比,可能导致成本效益较低的干预措施。这些结果表明,在成本效用分析中纳入亚组特异性 HU,可能为明智决策提供更多见解。