Health Information and Quality Authority, Dublin, Ireland.
Department of Public Health and Primary Care, Trinity College, Dublin, Ireland.
Diabet Med. 2017 Aug;34(8):1040-1049. doi: 10.1111/dme.13281. Epub 2016 Nov 29.
To systematically review the evidence on the costs and cost-effectiveness of self-management support interventions for people with diabetes.
Self-management support is the provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, potentially leading to improvements in HbA levels in people with diabetes.
Randomized controlled trials, observational studies or economic modelling studies were eligible for inclusion in the review. The target population was adults with diabetes. Interventions had to have a substantial component of self-management support and be compared with routine care. Study quality was evaluated using the Consensus on Health Economic Criteria and International Society of Pharmacoeconomic Outcomes Research questionnaires. A narrative review approach was used.
A total of 16 costing and 21 cost-effectiveness studies of a range of self-management support interventions were identified. There was reasonably consistent evidence across 22 studies evaluating education self-management support programmes suggesting these interventions are cost-effective or superior to usual care. Telemedicine-type interventions were more expensive than usual care and potentially not cost-effective. There was insufficient evidence regarding the other types of self-management interventions, including pharmacist-led and behavioural interventions. The identified studies were predominantly of poor quality, with outcomes based on short-term follow-up data and study designs at high risk of bias.
Self-management support education programmes may be cost-effective. There was limited evidence regarding other formats of self-management support interventions. The poor quality of many of the studies undermines the evidence base regarding the economic efficiency of self-management support interventions for people with diabetes.
系统评价针对糖尿病患者的自我管理支持干预措施的成本和成本效益的证据。
自我管理支持是提供教育和支持性干预措施，以提高患者管理健康问题的技能和信心，从而有可能改善糖尿病患者的糖化血红蛋白水平。
随机对照试验、观察性研究或经济建模研究符合纳入本综述的条件。目标人群是患有糖尿病的成年人。干预措施必须包含大量的自我管理支持内容，并与常规护理进行比较。使用共识健康经济标准和国际药物经济学结果研究协会问卷评估研究质量。采用叙述性综述方法。
共确定了 16 项成本核算和 21 项自我管理支持干预措施的成本效益研究。有 22 项评估教育自我管理支持计划的研究提供了较为一致的证据，表明这些干预措施具有成本效益或优于常规护理。远程医疗类型的干预措施比常规护理更昂贵，并且可能没有成本效益。关于其他类型的自我管理干预措施，包括药剂师主导的和行为干预措施，证据不足。已确定的研究主要质量较差，结果基于短期随访数据和存在高度偏倚风险的研究设计。
自我管理支持教育计划可能具有成本效益。关于其他形式的自我管理支持干预措施的证据有限。许多研究的质量较差，这削弱了针对糖尿病患者的自我管理支持干预措施的经济效率的证据基础。
