Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, U.K.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
Diabetes Care. 2020 Oct;43(10):2485-2492. doi: 10.2337/dc20-0717. Epub 2020 Aug 12.
To estimate using the UK Prospective Diabetes Study Outcomes Model Version 2 (UKPDS-OM2) the impact of delaying type 2 diabetes onset on costs and quality-adjusted life expectancy using trial participants who developed diabetes in the NAVIGATOR (Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research) study.
We simulated the impact of delaying diabetes onset by 1-9 years, utilizing data from the 3,058 of 9,306 NAVIGATOR trial participants who developed type 2 diabetes. Costs and utility weights associated with diabetes and diabetes-related complications were obtained for the U.S. and U.K. settings, with costs expressed in 2017 values. We estimated discounted lifetime costs and quality-adjusted life years (QALYs) with 95% CIs.
Gains in QALYs increased from 0.02 (U.S. setting, 95% CI 0.01, 0.03) to 0.15 (U.S. setting, 95% CI 0.10, 0.21) as the imposed time to diabetes onset was increased from 1 to 9 years, respectively. Savings in complication costs increased from $1,388 (95% CI $1,092, $1,669) for a 1-year delay to $8,437 (95% CI $6,611, $10,197) for a delay of 9 years. Interventions costing up to $567-$2,680 and £201-£947 per year would be cost-effective at $100,000 per QALY and £20,000 per QALY thresholds in the U.S. and U.K., respectively, as the modeled delay in diabetes onset was increased from 1 to 9 years.
Simulating a hypothetical diabetes-delaying intervention provides guidance concerning the maximum cost and minimum delay in diabetes onset needed to be cost-effective. These results can inform the ongoing debate about diabetes prevention strategies and the design of future intervention studies.
利用 NAVIGATOR（那格列奈和缬沙坦在糖耐量受损患者中的疗效研究）试验中发生 2 型糖尿病的 3058 名 9306 名参与者的数据，采用英国前瞻性糖尿病研究结果模型 2 版（UKPDS-OM2）估算延迟 2 型糖尿病发病对成本和质量调整生命预期的影响。
我们模拟通过将发病时间延迟 1-9 年来延迟糖尿病发病的影响，利用 NAVIGATOR 试验中 9306 名参与者中 3058 名发生 2 型糖尿病的参与者的数据。在美国和英国环境中获得与糖尿病和糖尿病相关并发症相关的成本和效用权重，成本用 2017 年的数值表示。我们使用 95%CI 估计了贴现终生成本和质量调整生命年（QALYs）。
在美国环境中，随着发病时间从 1 年延迟至 9 年，QALY 增加 0.02（95%CI，0.01，0.03）至 0.15（95%CI，0.10，0.21）。从延迟 1 年的并发症成本节省 1388 美元（95%CI，1092 美元，1669 美元）到延迟 9 年的节省 8437 美元（95%CI，6611 美元，10197 美元）。在美国和英国，成本为每年 567-2680 美元和每年 201-947 英镑的干预措施，在延迟 1-9 年的情况下，在 10 万美元/QALY 和 2 万英镑/QALY 的阈值下具有成本效益。
模拟假设的糖尿病延迟干预措施为具有成本效益的糖尿病发病延迟干预的最大成本和最小延迟提供了指导。这些结果可以为当前关于糖尿病预防策略的辩论和未来干预研究的设计提供信息。
