Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA(1c), weight and hypoglycaemic event incidence

作者：McEwan P^*; Bennett H; Bolin K; Evans M; Bergenheim K

来源：Diabetic Medicine, 2018, 35(5): 557-566.

DOI：10.1111/dme.13590

AimsInsulin therapy is indicated for people with Type 1 diabetes mellitus; however, treatment-related weight gain and hypoglycaemia represent barriers to optimal glycaemic management. This study assessed the health economic value of maintained reductions in HbA(1c), BMI and hypoglycaemia incidence among the UK Type 1 diabetes population.
MethodsThe Cardiff Type 1 Diabetes Model was used to estimate lifetime costs, life-years and quality-adjusted life-years (QALYs) for individuals with Type 1 diabetes at different baseline HbA(1c), BMI and hypoglycaemic event rates. Results were discounted at 3.5%, and the net monetary benefit associated with improving Type 1 diabetes management was derived at 20000/QALY gained. Per-person outputs were inflated to national levels using UK Type 1 diabetes prevalence estimates.
ResultsModelled subjects with an HbA(1c) of 86mmol/mol (10.0%) were associated with discounted lifetime per-person costs of 23795; 12649 of which may be avoided by maintaining an HbA(1c) of 42mmol/mol (6.0%). Combined with estimated QALY gains of 2.80, an HbA(1c) of 42mmol/mol (6.0%) vs. 86mmol/mol (10.0%) was associated with a 68621 per-person net monetary benefit. Over 1year, unit reductions in BMI produced 120 per-person net monetary benefit, and up to 197 pound for the avoidance of one non-severe hypoglyceamic event.
ConclusionsMaintained reductions in HbA(1c) significantly alleviate the burden associated with Type 1 diabetes in the UK. Given the influence of weight and hypoglycaemia on health economic outcomes, they must also be key considerations when assessing the value of Type 1 diabetes technologies in clinical practice.

• 出版日期2018-5