IMS Health, Basel, Switzerland.
IMS Health, Basel, Switzerland.
Value Health. 2014 Jun;17(4):462-70. doi: 10.1016/j.jval.2014.03.003. Epub 2014 May 17.
Economic analysis in type 2 diabetes mellitus (T2DM) requires an assessment of the effect of a wide range of complications. The objective of this article was to identify a set of utility values consistent with the National Institute for Health and Care Excellence (NICE) reference case and to critically discuss and illustrate challenges in creating such a utility set.
A systematic literature review was conducted to identify studies reporting utility values for relevant complications. The methodology of each study was assessed for consistency with the NICE reference case. A suggested set of utility values applicable to modeling was derived, giving preference to studies reporting multiple complications and correcting for comorbidity.
The review considered 21 relevant diabetes complications. A total of 16,574 articles were identified; after screening, 61 articles were assessed for methodological quality. Nineteen articles met NICE criteria, reporting utility values for 20 of 21 relevant complications. For renal transplant, because no articles meeting NICE criteria were identified, two articles using other methodologies were included. Index value estimates for T2DM without complication ranged from 0.711 to 0.940. Utility decrement associated with complications ranged from 0.014 (minor hypoglycemia) to 0.28 (amputation). Limitations associated with the selection of a utility value for use in economic modeling included variability in patient recruitment, heterogeneity in statistical analysis, large variability around some point estimates, and lack of recent data.
A reference set of utility values for T2DM and its complications in line with NICE requirements was identified. This research illustrates the challenges associated with systematically selecting utility data for economic evaluations.
2 型糖尿病（T2DM）的经济分析需要评估广泛并发症的影响。本文的目的是确定一组与英国国家卫生与保健优化研究所（NICE）参考病例一致的效用值，并批判性地讨论和说明创建此类效用集所面临的挑战。
进行了系统的文献回顾，以确定报告相关并发症效用值的研究。评估了每项研究的方法学是否符合 NICE 参考病例。提出了一套适用于建模的建议效用值，优先考虑报告多种并发症并纠正合并症的研究。
该综述考虑了 21 种相关的糖尿病并发症。共确定了 16,574 篇相关文章；经过筛选，对 61 篇文章进行了方法学质量评估。有 19 篇文章符合 NICE 标准，报告了 21 种相关并发症中的 20 种的效用值。对于肾移植，由于没有符合 NICE 标准的文章，因此纳入了两篇使用其他方法学的文章。无并发症的 T2DM 的指数值估计范围为 0.711 至 0.940。与并发症相关的效用下降范围从 0.014（轻度低血糖）到 0.28（截肢）。在为经济建模选择效用值时，存在一些局限性，包括患者招募的可变性、统计分析的异质性、一些点估计值的很大可变性以及缺乏最新数据。
确定了一组符合 NICE 要求的 T2DM 及其并发症的参考效用值。这项研究说明了在系统选择用于经济评估的效用数据时所面临的挑战。
