Lian J X, McGhee S M, Chau J, Wong Carlos K H, Lam Cindy L K, Wong William C W
Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong.
School of Public Health, The University of Hong Kong, Hong Kong.
Diabetes Res Clin Pract. 2017 May;127:21-34. doi: 10.1016/j.diabres.2017.02.021. Epub 2017 Feb 22.
A review of cost-effectiveness studies on self-management education programmes for Type 2 diabetes mellitus.
Cochrane, PubMed and PsycINFO databases were searched for papers published from January 2003 through September 2015. Further hand searching using the reference lists of included papers was carried out.
In total, 777 papers were identified and 12 papers were finally included. We found eight programmes whose effectiveness analyses were based on randomised controlled trials and whose costs were comprehensively estimated from the stated perspective. Among these eight, four studies showed a cost per unit reduction in clinical risk factors (HbA1c or BMI) of US$491 to US$7723 or cost per glycaemic symptom day avoided of US$39. In three studies the cost per QALY gained, as estimated from a life-time model, was less than US$50,000. However, one study found the programme was not cost-effective despite a gain in QALYs at the one-year follow up.
A small number of cost-effectiveness studies were identified with only eight of sufficiently good quality. The cost of a self-management education programme achieving reduction in clinical risk factors seems to be modest and is likely to be cost-effective in the long-term.
对2型糖尿病自我管理教育项目的成本效益研究进行综述。
检索Cochrane、PubMed和PsycINFO数据库，查找2003年1月至2015年9月发表的论文。还利用纳入论文的参考文献列表进行了进一步的手工检索。
共识别出777篇论文，最终纳入12篇。我们发现有8个项目的有效性分析基于随机对照试验，且从规定角度对成本进行了全面估算。在这8个项目中，4项研究显示临床风险因素（糖化血红蛋白或体重指数）每单位降低的成本为491美元至7723美元，或避免血糖症状天数的成本为39美元。在3项研究中，根据终生模型估算，每获得一个质量调整生命年的成本低于50,000美元。然而，一项研究发现该项目尽管在一年随访时质量调整生命年有所增加，但并不具有成本效益。
仅识别出少数成本效益研究，其中只有8项质量足够好。实现临床风险因素降低的自我管理教育项目成本似乎适中，从长期来看可能具有成本效益。
