Evidera, Bocskai út 134-146. E/2, 1113, Budapest, Hungary.
Eli Lilly and Company, Indianapolis, IN, USA.
Pharmacoeconomics. 2022 Aug;40(8):743-750. doi: 10.1007/s40273-022-01148-4. Epub 2022 Jun 7.
Economic models in type 1 diabetes have relied on a change in haemoglobin A1c as the link between the blood glucose trajectory and long-term clinical outcomes, including microvascular and macrovascular disease. The landscape has changed in the past decade with the availability of regulatory approved, accurate and convenient continuous glucose monitoring devices and their ability to track patients' glucose levels over time. The data emerging from continuous glucose monitoring have enriched the clinical understanding of the disease and indirectly of patients' behaviour. This has triggered the development of new measures proposed to better define the quality of glycaemic control, beyond haemoglobin A1c. The objective of this paper is to review recent developments in clinical knowledge brought into focus with the application of continuous glucose monitoring devices, and to discuss potential approaches to incorporate the concepts into economic models in type 1 diabetes. Based on a targeted review and a series of multidisciplinary workshops, an influence diagram was developed that captures newer concepts (e.g. continuous glucose monitoring metrics) that can be integrated into economic models and illustrates their association with more established concepts. How the additional continuous glucose monitoring-based indicators of glycaemic control may contribute to economic modelling beyond haemoglobin A1c, and more accurately reflect the economic value of novel type 1 diabetes treatments, is discussed.
在 1 型糖尿病中，经济模型一直依赖于糖化血红蛋白的变化，将血糖轨迹与长期临床结果（包括微血管和大血管疾病）联系起来。在过去十年中，随着监管批准的准确、便捷的连续血糖监测设备的出现，以及它们能够随时间跟踪患者的血糖水平，这种情况发生了变化。连续血糖监测数据丰富了对该疾病的临床认识，并间接地丰富了对患者行为的认识。这引发了新措施的发展，这些措施旨在更好地定义血糖控制质量，超越糖化血红蛋白。本文的目的是回顾随着连续血糖监测设备的应用而聚焦的临床知识的最新进展，并讨论将这些概念纳入 1 型糖尿病经济模型的潜在方法。基于有针对性的审查和一系列多学科研讨会，开发了一个影响图，该图捕获了可以整合到经济模型中的更新概念（例如连续血糖监测指标），并说明了它们与更成熟概念的关联。讨论了基于连续血糖监测的血糖控制新指标如何超越糖化血红蛋白对经济建模做出贡献，并更准确地反映新型 1 型糖尿病治疗的经济价值。
