Diabetes Research Centre, University of Leicester, Leicester, UK.
Diabetes Research Centre, University of Leicester, Leicester, UK; NIHR Applied Research Collaborations - East Midlands (NIHR ARC - EM), Leicester, UK.
Diabetes Res Clin Pract. 2020 Mar;161:108073. doi: 10.1016/j.diabres.2020.108073. Epub 2020 Feb 12.
The objective of this systematic review is to identify and assess the quality of published decision-analytic models evaluating the long-term cost-effectiveness of target-driven intensive interventions for single and multifactorial risk factor control compared to standard care in people with type 2 diabetes.
We searched the electronic databases MEDLINE, the National Health Service Economic Evaluation Database, Web of Science and the Cochrane Library from inception to October 31, 2019. Articles were eligible for inclusion if the studies had used a decision-analytic model evaluating both the long-term costs and benefits associated with intensive interventions for risk factor control compared to standard care in people with type 2 diabetes. Data were extracted using a standardised form, while quality was assessed using the decision-analytic model-specific Philips-criteria.
Overall, nine articles (11 models) were identified, four models evaluated intensive glycaemic control, three evaluated intensive blood pressure control, two evaluated intensive lipid control, and two evaluated intensive multifactorial interventions. Six reported using discrete-time simulations modelling approach, whereas five reported using a Markov modelling framework. The majority, seven studies, reported that the intensive interventions were dominant or cost-effective, given the assumptions and analytical perspective taken. The methodological and reporting quality of the studies was generally weak, with only four studies fulfilling more than 50% of their applicable Philips-criteria.
This is the first systematic review of decision-analytic models of target-driven intensive interventions for single and multifactorial risk factor control in individuals with type 2 diabetes. Identified shortcomings are lack of transparency in data identification and evidence synthesis as well as for the selection of the modelling approaches. Future models should aim to include greater evaluation of the quality of the data sources used and the assessment of uncertainty in the model.
本系统评价的目的是确定并评估已发表的决策分析模型的质量，这些模型评估了针对 2 型糖尿病患者单一和多因素危险因素控制的目标驱动强化干预与标准护理相比的长期成本效益。
我们检索了电子数据库 MEDLINE、英国国家卫生服务经济评价数据库、Web of Science 和 Cochrane Library，检索时间截至 2019 年 10 月 31 日。如果研究使用决策分析模型评估了与标准护理相比，针对 2 型糖尿病患者的危险因素控制的强化干预的长期成本和效益，则符合纳入标准。使用标准化表格提取数据，同时使用决策分析模型特定的飞利浦标准评估质量。
总体而言，确定了 9 篇文章（11 个模型），其中 4 个模型评估了强化血糖控制，3 个评估了强化血压控制，2 个评估了强化血脂控制，2 个评估了强化多因素干预。6 项研究报告使用离散时间模拟建模方法，5 项报告使用马尔可夫建模框架。基于所采用的假设和分析视角，大多数（7 项研究）报告强化干预具有优势或具有成本效益。研究的方法学和报告质量普遍较弱，只有 4 项研究符合飞利浦标准的 50%以上。
这是首次对 2 型糖尿病患者单一和多因素危险因素控制的目标驱动强化干预的决策分析模型进行的系统评价。确定的不足之处在于数据识别和证据综合以及建模方法选择方面缺乏透明度。未来的模型应旨在提高对所用数据源质量的评估，并评估模型中的不确定性。
