RTI International, Research Triangle Park, NC, USA.
RTI International, Research Triangle Park, NC, USA.
Value Health. 2023 Sep;26(9):1372-1380. doi: 10.1016/j.jval.2023.05.013. Epub 2023 May 24.
This study aimed to develop a microsimulation model to estimate the health effects, costs, and cost-effectiveness of public health and clinical interventions for preventing/managing type 2 diabetes.
We combined newly developed equations for complications, mortality, risk factor progression, patient utility, and cost-all based on US studies-in a microsimulation model. We performed internal and external validation of the model. To demonstrate the model's utility, we predicted remaining life-years, quality-adjusted life-years (QALYs), and lifetime medical cost for a representative cohort of 10 000 US adults with type 2 diabetes. We then estimated the cost-effectiveness of reducing hemoglobin A1c from 9% to 7% among adults with type 2 diabetes, using low-cost, generic, oral medications.
The model performed well in internal validation; the average absolute difference between simulated and observed incidence for 17 complications was < 8%. In external validation, the model was better at predicting outcomes in clinical trials than in observational studies. The cohort of US adults with type 2 diabetes was projected to have an average of 19.95 remaining life-years (from mean age 61), incur $187 729 in discounted medical costs, and accrue 8.79 discounted QALYs. The intervention to reduce hemoglobin A1c increased medical costs by $1256 and QALYs by 0.39, yielding an incremental cost-effectiveness ratio of $9103 per QALY.
Using equations exclusively derived from US studies, this new microsimulation model achieves good prediction accuracy in US populations. The model can be used to estimate the long-term health impact, costs, and cost-effectiveness of interventions for type 2 diabetes in the United States.
本研究旨在开发一个微观模拟模型，以估计预防/管理 2 型糖尿病的公共卫生和临床干预措施的健康效果、成本和成本效益。
我们在微观模拟模型中结合了新开发的并发症、死亡率、风险因素进展、患者效用和成本方程——所有这些都基于美国的研究。我们对模型进行了内部和外部验证。为了展示模型的实用性，我们预测了 10000 名美国 2 型糖尿病患者代表性队列的剩余寿命年、质量调整生命年（QALY）和终生医疗费用。然后，我们使用低成本、通用、口服药物来估计降低 2 型糖尿病患者血红蛋白 A1c 从 9%至 7%的成本效益。
模型在内部验证中表现良好；17 种并发症的模拟和观察发生率之间的平均绝对差异<8%。在外部验证中，模型在预测临床试验结果方面优于观察性研究。美国 2 型糖尿病患者队列预计平均剩余寿命为 19.95 年（从平均年龄 61 岁开始），预计将产生 187729 美元的折扣医疗费用，并获得 8.79 个折扣 QALY。降低血红蛋白 A1c 的干预措施增加了 1256 美元的医疗费用和 0.39 个 QALY，增量成本效益比为每 QALY 9103 美元。
使用完全从美国研究中得出的方程，这个新的微观模拟模型在美国家庭中达到了较高的预测准确性。该模型可用于估计美国 2 型糖尿病干预措施的长期健康影响、成本和成本效益。
