The Swedish Institute for Health Economics, Box 2017, 220 02, Lund, Sweden.
Novo Nordisk A/S, Søborg, Denmark.
Pharmacoeconomics. 2020 Sep;38(9):953-969. doi: 10.1007/s40273-020-00922-6.
Economic modeling is widely used in estimating cost-effectiveness in type 2 diabetes mellitus. Because type 2 diabetes is complex and patients are heterogenous, the cohort modeling approach may generate biased estimates of costeffectiveness. The IHE Diabetes Cohort Model (IHE-DCM) was constructed using the cohort approach as an alternative for stakeholders with limited resources, some of whom have voiced reasonable concerns about a lack of transparency with type 2 diabetes micro-simulation models and long run times.
The objective of this study was to inform decision makers by investigating the direction and magnitude of bias of IHE-DCM cost-effectiveness estimates that can be attributed to the cohort modeling approach.
Simulation scenarios inspired by the 9th Mount Hood Diabetes Challenge were simulated with IHE-DCM and with a micro-simulation model, the Economic and Health Outcomes Model of T2DM (ECHO-T2DM), and key metrics (absolute and incremental costs and quality-adjusted life-years, event rates, and cost-effectiveness) were compared for evidence of systematic differences. The models were harmonized to the extent possible to ensure that differences were driven primarily by the unit of observation and not by other model differences.
IHE-DCM run times were faster and IHE-DCM produced uniformly larger estimates of absolute life-years, quality-adjusted life-years, and costs than ECHO-T2DM but smaller between-arm (incremental) differences. Estimated incremental cost-effectiveness ratios and net monetary benefits varied similarly and predictably across the scenarios. On average, IHE-DCM estimates of incremental cost-effectiveness ratios and net monetary benefits were CAN$269 (3%) and CAN$2935 (10%) smaller, respectively, than ECHO-T2DM.
There was little evidence that estimated cost-effectiveness metrics, the outcomes that matter most to stakeholders, differed systematically.
经济建模在估计 2 型糖尿病的成本效益方面被广泛应用。由于 2 型糖尿病的复杂性和患者的异质性，队列建模方法可能会对成本效益的估计产生偏差。IHE 糖尿病队列模型（IHE-DCM）是使用队列方法构建的，是资源有限的利益相关者的替代方法，其中一些人对 2 型糖尿病微观模拟模型缺乏透明度和较长的运行时间表示合理关切。
本研究的目的是通过调查 IHE-DCM 成本效益估计的偏差方向和幅度，为决策者提供信息，这些偏差可以归因于队列建模方法。
受第 9 届胡德山糖尿病挑战赛启发的模拟场景分别用 IHE-DCM 和微观模拟模型经济和 2 型糖尿病健康结果模型（ECHO-T2DM）进行模拟，并对关键指标（绝对和增量成本、质量调整生命年、事件率和成本效益）进行比较，以证明是否存在系统差异。对模型进行了尽可能的协调，以确保差异主要是由观察单位驱动的，而不是由其他模型差异驱动的。
IHE-DCM 的运行速度更快，与 ECHO-T2DM 相比，IHE-DCM 产生的绝对生命年、质量调整生命年和成本的估计值普遍较大，但臂间（增量）差异较小。估计的增量成本效益比和净货币效益在不同情况下变化相似且可预测。平均而言，IHE-DCM 对增量成本效益比和净货币效益的估计分别比 ECHO-T2DM 低 269 加元（3%）和 2935 加元（10%）。
没有证据表明，对成本效益衡量标准的估计，即对利益相关者最重要的结果，存在系统差异。
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