Hua Xinyang, Lung Thomas Wai-Chun, Palmer Andrew, Si Lei, Herman William H, Clarke Philip
School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
The George Institute for Global Health, University of Sydney, Lidcombe, NSW, Australia.
Pharmacoeconomics. 2017 Mar;35(3):319-329. doi: 10.1007/s40273-016-0466-0.
There are an increasing number of studies using simulation models to conduct cost-effectiveness analyses for type 2 diabetes mellitus.
To evaluate the relationship between improvements in glycosylated haemoglobin (HbA) and simulated health outcomes in type 2 diabetes cost-effectiveness studies.
A systematic review was conducted on MEDLINE and EMBASE to collect cost-effectiveness studies using type 2 diabetes simulation models that reported modelled health outcomes of blood glucose-related interventions in terms of quality-adjusted life-years (QALYs) or life expectancy (LE). The data extracted included information used to characterise the study cohort, the intervention's treatment effects on risk factors and model outcomes. Linear regressions were used to test the relationship between the difference in HbA (∆HbA) and incremental QALYs (∆QALYs) or LE (∆LE) of intervention and control groups. The ratio between the ∆QALYs and ∆LE was calculated and a scatterplot between the ratio and ∆HbA was used to explore the relationship between these two.
Seventy-six studies were included in this research, contributing to 124 pair of comparators. The pooled regressions indicated that the marginal effect of a 1% HbA decrease in intervention resulted in an increase in life-time QALYs and LE of 0.371 (95% confidence interval 0.286-0.456) and 0.642 (95% CI 0.494-0.790), respectively. No evidence of heterogeneity between models was found. An inverse exponential relationship was found and fitted between the ratio (∆QALY/∆LE) and ∆HbA.
There is a consistent relationship between ∆HbA and ∆QALYs or ∆LE in cost-effectiveness analyses using type 2 diabetes simulation models. This relationship can be used as a diagnostic tool for decision makers.
使用模拟模型对2型糖尿病进行成本效益分析的研究越来越多。
评估2型糖尿病成本效益研究中糖化血红蛋白（HbA）改善与模拟健康结果之间的关系。
对MEDLINE和EMBASE进行系统综述，以收集使用2型糖尿病模拟模型的成本效益研究，这些研究报告了血糖相关干预措施在质量调整生命年（QALYs）或预期寿命（LE）方面的模拟健康结果。提取的数据包括用于描述研究队列的信息、干预对危险因素的治疗效果和模型结果。使用线性回归来检验干预组和对照组之间HbA差异（∆HbA）与增量QALYs（∆QALYs）或LE（∆LE）之间的关系。计算∆QALYs与∆LE之间的比率，并使用该比率与∆HbA之间的散点图来探索两者之间的关系。
本研究纳入了76项研究，形成了124对比较对象。汇总回归表明，干预组HbA降低1%的边际效应分别导致终身QALYs增加0.371（95%置信区间0.286 - 0.456）和LE增加0.642（95%CI 0.494 - 0.790）。未发现模型之间存在异质性证据。发现比率（∆QALY/∆LE）与∆HbA之间存在逆指数关系并进行了拟合。
在使用2型糖尿病模拟模型的成本效益分析中，∆HbA与∆QALYs或∆LE之间存在一致的关系。这种关系可作为决策者的诊断工具。
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