Department of Public Health and Epidemiology, Faculty of Pharmaceutical Sciences, Meiji Pharmaceutical University, Tokyo, Japan
Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Diabetes Care. 2018 Jun;41(6):1218-1226. doi: 10.2337/dc17-1307. Epub 2018 Apr 23.
A new opportunistic community-based strategy was launched in Japan in April 2014 to detect lifestyle-related diseases, including diabetes, by creating Specimen Measurement Offices (SMOs). SMOs offer walk-in fingertip HbA testing. This article aimed to assess the value-for-money of HbA testing services at SMOs by conducting a cost-effectiveness analysis.
We compared two scenarios: ) status quo, defined as HbA testing that is available only through conventional screening, and ) HbA testing available at SMOs as a complement to the status quo scenario. The model consisted of a screening module with a decision tree and a disease progression module with a Markov model. We calculated incremental cost-effectiveness ratios (i.e., cost per quality-adjusted life-years [QALYs]) over the lifetime analytic horizon as the primary end point of the cost-effectiveness analysis. In this model, we assumed the participant cohort to be people 40-74 years of age who sought walk-in fingertip HbA testing at SMOs on the premises of community pharmacies. Costs and outcomes were discounted at a rate of 3%. The cost-effectiveness was analyzed from a societal perspective.
The incremental cost per individual for those 40-74 years of age was estimated to be -527 U.S. dollars (USD) (-52,722 Japanese yen [JPY]) for HbA testing at SMOs compared with the status quo. Incremental effectiveness was estimated to be 0.0203 QALYs for HbA testing at SMOs compared with the status quo. Therefore, this cost-effectiveness analysis showed that compared with the status quo, HbA testing at SMOs was more effective and had lower cost for the population studied.
We consider our results to be robust because most simulations were under the threshold of USD 50,000 (JPY 5,000,000) per QALYs gained, by sensitivity analysis. These results will be useful to managers of pharmacies or other health institutions and/or policy makers in local government.
2014 年 4 月，日本推出了一项新的机会主义社区基础策略，通过创建标本测量办公室（SMO）来检测与生活方式相关的疾病，包括糖尿病。SMO 提供现场指尖 HbA 检测。本文旨在通过成本效益分析评估 SMO 中 HbA 检测服务的价值。
我们比较了两种情况：）现状，定义为仅通过常规筛查提供的 HbA 检测，和）SMO 提供的 HbA 检测作为现状的补充。该模型由一个具有决策树的筛查模块和一个具有马尔可夫模型的疾病进展模块组成。我们计算了终生分析期内的增量成本效益比（即每质量调整生命年[QALY]的成本）作为成本效益分析的主要终点。在这个模型中，我们假设参与者队列是年龄在 40-74 岁之间的人，他们在社区药店的 SMO 场所寻求现场指尖 HbA 检测。成本和结果以 3%的贴现率贴现。从社会角度分析了成本效益。
40-74 岁人群的个体增量成本估计为 SMO 进行 HbA 检测比现状低 527 美元（52722 日元）。SMO 进行 HbA 检测的增量效果估计为比现状增加 0.0203 QALY。因此，与现状相比，这项成本效益分析表明，对于所研究的人群，SMO 进行的 HbA 检测更有效且成本更低。
我们认为我们的结果是稳健的，因为大多数模拟都在每获得一个 QALY 的成本低于 50000 美元（5000000 日元）的阈值内，通过敏感性分析。这些结果将对药店或其他医疗机构的管理人员和/或地方政府的政策制定者有用。
