Breeze P R, Thomas C, Squires H, Brennan A, Greaves C, Diggle P J, Brunner E, Tabak A, Preston L, Chilcott J
School of Health and Related Research, University of Sheffield, Sheffield, UK.
Medical School, University of Exeter, Exeter, UK.
Diabet Med. 2017 May;34(5):632-640. doi: 10.1111/dme.13314. Epub 2017 Mar 10.
To develop a cost-effectiveness model to compare Type 2 diabetes prevention programmes targeting different at-risk population subgroups with a lifestyle intervention of varying intensity.
An individual patient simulation model was constructed to simulate the development of diabetes in a representative sample of adults without diabetes from the UK population. The model incorporates trajectories for HbA , 2-h glucose, fasting plasma glucose, BMI, systolic blood pressure, total cholesterol and HDL cholesterol. Patients can be diagnosed with diabetes, cardiovascular disease, microvascular complications of diabetes, cancer, osteoarthritis and depression, or can die. The model collects costs and utilities over a lifetime horizon. The perspective is the UK National Health Service and personal social services. We used the model to evaluate the population-wide impact of targeting a lifestyle intervention of varying intensity to six population subgroups defined as high risk for diabetes.
The intervention produces 0.0003 to 0.0009 incremental quality-adjusted life years and saves up to £1.04 per person in the general population, depending upon the subgroup targeted. Cost-effectiveness increases with intervention intensity. The most cost-effective options are to target individuals with HbA > 42 mmol/mol (6%) or with a high Finnish Diabetes Risk (FINDRISC) probability score (> 0.1).
The model indicates that diabetes prevention interventions are likely to be cost-effective and may be cost-saving over a lifetime. In the model, the criteria for selecting at-risk individuals differentially impact upon diabetes and cardiovascular disease outcomes, and on the timing of benefits. These findings have implications for deciding who should be targeted for diabetes prevention interventions.
建立一个成本效益模型，以比较针对不同糖尿病高危人群亚组的2型糖尿病预防计划与不同强度的生活方式干预措施。
构建一个个体患者模拟模型，以模拟来自英国人群的无糖尿病成年人代表性样本中糖尿病的发展情况。该模型纳入了糖化血红蛋白（HbA）、2小时血糖、空腹血糖、体重指数（BMI）、收缩压、总胆固醇和高密度脂蛋白胆固醇的变化轨迹。患者可能被诊断为糖尿病、心血管疾病、糖尿病微血管并发症、癌症、骨关节炎和抑郁症，或者可能死亡。该模型收集终身范围内的成本和效用。视角是英国国家医疗服务体系和个人社会服务。我们使用该模型评估针对定义为糖尿病高危人群的六个亚组进行不同强度生活方式干预对全人群的影响。
根据所针对的亚组不同，该干预措施可产生0.0003至0.0009个增量质量调整生命年，并且在普通人群中每人最多可节省1.04英镑。成本效益随着干预强度的增加而提高。最具成本效益的选择是针对糖化血红蛋白>42 mmol/mol（6%）或芬兰糖尿病风险（FINDRISC）概率评分高（>0.1）的个体。
该模型表明，糖尿病预防干预措施可能具有成本效益，并且在一生中可能节省成本。在该模型中，选择高危个体的标准对糖尿病和心血管疾病结局以及获益时间有不同影响。这些发现对决定谁应成为糖尿病预防干预的目标人群具有启示意义。
