Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
Health Technology Assessment Unit (HTAU), College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
J Diabetes. 2024 May;16(5):e13553. doi: 10.1111/1753-0407.13553.
Prediabetes management is a priority for policymakers globally, to avoid/delay type 2 diabetes (T2D) and reduce severe, costly health consequences. Countries moving from low to middle income are most at risk from the T2D "epidemic" and may find implementing preventative measures challenging; yet prevention has largely been evaluated in developed countries.
Markov cohort simulations explored costs and benefits of various prediabetes management approaches, expressed as "savings" to the public health care system, for three countries with high prediabetes prevalence and contrasting economic status (Poland, Saudi Arabia, Vietnam). Two scenarios were compared up to 15 y: "inaction" (no prediabetes intervention) and "intervention" with metformin extended release (ER), intensive lifestyle change (ILC), ILC with metformin (ER), or ILC with metformin (ER) "titration."
T2D was the highest-cost health state at all time horizons due to resource use, and inaction produced the highest T2D costs, ranging from 9% to 34% of total health care resource costs. All interventions reduced T2D versus inaction, the most effective being ILC + metformin (ER) "titration" (39% reduction at 5 y). Metformin (ER) was the only strategy that produced net saving across the time horizon; however, relative total health care system costs of other interventions vs inaction declined over time up to 15 y. Viet Nam was most sensitive to cost and parameter changes via a one-way sensitivity analysis.
Metformin (ER) and lifestyle interventions for prediabetes offer promise for reducing T2D incidence. Metformin (ER) could reduce T2D patient numbers and health care costs, given concerns regarding adherence in the context of funding/reimbursement challenges for lifestyle interventions.
糖尿病前期管理是全球政策制定者的重点，目的是避免/延缓 2 型糖尿病（T2D）的发生，并降低严重的、高成本的健康后果。从中等收入国家向低收入国家过渡的过程中，面临着 T2D“流行”的最大风险，实施预防措施可能具有挑战性；然而，预防措施在很大程度上仅在发达国家进行了评估。
采用马尔可夫队列模拟方法，对三种糖尿病前期患病率高且经济状况差异较大的国家（波兰、沙特阿拉伯和越南）的各种糖尿病前期管理方法的成本效益进行了评估，其效益表示为对公共医疗保健系统的“节省”。比较了两种方案，持续时间长达 15 年：“不干预”（不进行糖尿病前期干预）和“干预”，即使用二甲双胍缓释片（ER）、强化生活方式改变（ILC）、ILC 联合二甲双胍（ER）或 ILC 联合二甲双胍（ER）“滴定”。
在所有时间点，T2D 都是导致资源利用的最高成本健康状态，不干预会产生最高的 T2D 成本，占总医疗保健资源成本的 9%至 34%。与不干预相比，所有干预措施均降低了 T2D 发生的风险，其中最有效的是 ILC+二甲双胍（ER）“滴定”（5 年内降低 39%）。二甲双胍（ER）是唯一在整个时间范围内产生净节省的策略；然而，与不干预相比，其他干预措施的相对总医疗保健系统成本在 15 年内呈下降趋势。通过单向敏感性分析，越南对成本和参数变化最为敏感。
二甲双胍（ER）和生活方式干预措施对糖尿病前期具有降低 T2D 发生率的潜力。考虑到在生活方式干预措施面临资金/报销挑战的情况下，二甲双胍（ER）可能会降低 T2D 患者数量和医疗保健成本。
