Health Utilities of Type 2 Diabetes-Related Complications:  A Cross-Sectional Study in Sweden

Kiadaliri, Aliasghar Ahmad; Gerdtham, Ulf G.; Eliasson, Björn; Guðbjörnsdóttir, Soffia; Svensson, Ann‐Marie; Carlsson, Katarina Steen

doi:10.3390/ijerph110504939

Cited by 28 publications

(43 citation statements)

References 44 publications

(63 reference statements)

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“…The impact is higher than the combination of weight loss of 5 kg compared to weight gain of 2 kg implying that avoiding weight gain is more important than weight loss. These results are in alignment with other similar studies [24–26]. A recent study that aimed to estimate utility values for hypothetical health states associated with differences in weight and quality of life in Canadians with T2D showed for every decrease of 1 kg/m [2] BMI there was an associated increase in utility of 0.0171 (95 % CI: 0.0103, 0.0238) [26].…”

Section: Discussionsupporting

confidence: 87%

Estimating the impact of changes in HbA1c, body weight and insulin injection regimen on health related quality-of-life: a time trade off study

Ridderstråle

Evans

Jensen³

et al. 2016

Health Qual Life Outcomes

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BackgroundThere are limited data on the potential short-term benefits associated with reductions in HbA1c levels, and understanding any immediate improvements in health related quality-of-life (HRQoL) through better glycaemic control may help inform diabetes management decisions. This time-trade-off (TTO) study investigated the short-term impact on HRQoL associated with three different aspects of diabetes management; HbA1c change, body weight change, and the complexity of treatment regimen.MethodsThe study was designed in three stages: Stage 1) Qualitative telephone interviews with people with type 2 diabetes (T2D) in Denmark who had experienced a decrease in their HbA1c level. Stage 2) A validation survey with people with T2D in Denmark to obtain quantifiable knowledge on the short-term effects of a change in HbA1c levels. Stage 3) TTO survey using health states based on results from stage 2. Respondents were either adults with T2D (Sweden) or from the general public (UK and Denmark) and were separately asked to evaluate seven health states through an internet-based survey.ResultsResults from 4060 respondents were available for the TTO analysis (UK n = 1777; Denmark n = 1799, Sweden n = 484). ‘Well-controlled diabetes’ was associated with utilities of 0.85–0.91 and ‘not well-controlled diabetes’ with utilities of 0.71–0.80 in all countries. Difference in utilities per HbA1c percentage point was smallest in Sweden and largest in Denmark (between 0.025–0.034 per HbA1c percentage point respectively). The treatment management health state associated with the lowest disutility was the once-daily insulin regimen. The disutility associated with per kg of weight change ranged from 0.0041–0.0073.ConclusionsChanges in HbA1c levels, insulin regimen and body weight are all likely to affect HRQoL for patients with T2D. A change in HbA1c is likely to have a short-term impact in addition to the effect on the development of long term diabetes complications. A treatment which has a simple regimen with fewer injections, and/or the need for less planning, and that causes weight loss or less weight gain, compared with other treatments, will have a positive impact on HRQoL.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-016-0411-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 87%

Estimating the impact of changes in HbA1c, body weight and insulin injection regimen on health related quality-of-life: a time trade off study

Ridderstråle

Evans

Jensen³

et al. 2016

Health Qual Life Outcomes

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“…Our findings are consistent with previous studies. In the UK, patients with type 2 diabetes and kidney disorders had the greatest decline in health utility, while in Sweden, patients with type 2 diabetes and stroke had the greatest decline in health utility [18]. Hypertension, obesity, and dyslipidemia were found to be highly prevalent among patients with type 2 diabetes receiving oral medications in a crosssectional study at outpatient clinics in Bangladesh [19].…”

Section: Discussionmentioning

confidence: 96%

EQ-5D-3L Decrements by Diabetes Complications and Comorbidities in China

Zhang

Chen

et al. 2020

Diabetes Ther

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Introduction: Patients with type 2 diabetes have lower quality of life, which is further impaired by diabetes complications and comorbidities. This study aims to evaluate the impact of diabetes complications and comorbidities on EuroQol Five-Dimension Three-Level (EQ-5D-3L) scores among patients with type 2 diabetes with ongoing oral drug treatments in China. Methods: This retrospective cross-sectional analysis included 9570 patients with type 2 diabetes on oral drug treatments, who were enrolled from 75 hospitals in nine cities in China. Patient characteristics, including demographic data, health conditions, oral treatment history, and health insurance coverage, were collected through self-reported questionnaires. Health utility was measured by the EQ-5D-3L scale in the questionnaire and a Chinese version of the EQ-5D-3L scoring weights was applied in the analysis. The associations between complications and health utility were assessed using linear regression. Results: A total of 7081 patients with complete survey data were included in the analytic sample; 3479 (49.13%) patients were female. The mean age was 59.6 years old, with a standard deviation (SD) of 12.64. The average duration with type 2 diabetes was 7.91 (SD = 6.22) years. A total of 5189 (73.28%) patients reported complications. Hypertension (51.25%) and hyperlipidemia (28.90%) were the most common complications. Other complications reported by patients included cardiovascular disease, stroke, retinopathy, nephropathy, diabetic foot, and hypoglycemia. On average, each patient had 1.54 complications. All complications and comorbidities decreased the EQ-5D-3L score. Among patients with complications, the worst effect on EQ-5D-3L score was caused by diabetic foot, decreasing by 0.118 (p \ 0.001), followed by stroke (decreasing by 0.101, p \ 0.001) and nephropathy (decreasing by 0.058, p \ 0.001). Conclusion: The diabetes complications and comorbidities among patients with type 2 diabetes were associated with poor health utility scores, especially for those with diabetic foot, stroke, and nephropathy. Key Summary PointsSeventy-three percent of the Chinese patients with type 2 diabetes surveyed had at least one diabetes complication.Increased numbers of diabetes complications are associated with worse EQ-5D utility index and EQ-5D VAS score.Cardiovascular disease, stroke, retinopathy, nephropathy, diabetic foot, and symptomatic hypoglycemia event were associated with EQ-5D disutility of 0.007-0.118.Duration of type 2 diabetes for 10 years or longer had lower EQ-5D utility by 0.014.

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“…Baseline utility was modeled using data from a recent study on EQ-5D scores in Swedish T2DM patients with no complications [ 55 ]. Health state utilities for T2DM-related complications and utility decrements associated with age, gender, duration of diabetes, and BMI were derived, whenever possible, from Sweden-specific published sources, supplemented with data from other sources if necessary (Table 2 in supplement).…”

Section: Methodsmentioning

confidence: 99%

Cost–Utility Analysis of Glucagon-Like Peptide-1 Agonists Compared with Dipeptidyl Peptidase-4 Inhibitors or Neutral Protamine Hagedorn Basal Insulin as Add-On to Metformin in Type 2 Diabetes in Sweden

et al. 2014

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IntroductionThis study aimed to assess the costs and benefits of three alternative second-line treatment strategies for Swedish patients with type 2 diabetes mellitus (T2DM) who fail to reach glycated hemoglobin (HbA1c) ≤ 7% with metformin treatment alone: glucagon-like peptide-1 (GLP-1) receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, and neutral protamine Hagedorn (NPH) insulin.MethodsA previously developed cohort model for T2DM was applied over a 35-year time horizon. Data on T2DM patients on metformin monotherapy with HbA1c > 7% were collected from the Swedish National Diabetes Register. Treatment effects were taken from published studies. Costs and effects were discounted at 3% per annum, and the analysis was conducted from a societal perspective. The robustness of the results was evaluated using one-way and probabilistic sensitivity analyses.ResultsTreatment with GLP-1 agonists was associated with a discounted incremental benefit of 0.10 and 0.25 quality-adjusted life years (QALYs) and higher discounted costs of Swedish Krona (SEK) 34,865 and SEK 40,802 compared with DPP-4 inhibitors and NPH insulin, respectively. Assuming willingness-to-pay (WTP) of SEK 500,000 per QALY, treatment strategy with GLP-1 agonists was a cost-effective option with incremental cost-effectiveness ratios of SEK 353,172 and SEK 160,618 per QALY gained versus DPP-4 inhibitors and NPH insulin, respectively. The results were most sensitive to incidence rate of moderate/major hypoglycemia and disutilities associated with insulin treatment, body mass index (BMI), and hypoglycemia.ConclusionAssuming a WTP of SEK 500,000 per QALY, treatment strategy with GLP-1 agonists is a cost-effective strategy in comparison to DPP-4 inhibitors and NPH insulin among T2DM patients inadequately controlled with metformin alone in a Swedish setting.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-014-0080-0) contains supplementary material, which is available to authorized users.

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Health Utilities of Type 2 Diabetes-Related Complications: A Cross-Sectional Study in Sweden

Cited by 28 publications

References 44 publications

Estimating the impact of changes in HbA1c, body weight and insulin injection regimen on health related quality-of-life: a time trade off study

Estimating the impact of changes in HbA1c, body weight and insulin injection regimen on health related quality-of-life: a time trade off study

EQ-5D-3L Decrements by Diabetes Complications and Comorbidities in China

Cost–Utility Analysis of Glucagon-Like Peptide-1 Agonists Compared with Dipeptidyl Peptidase-4 Inhibitors or Neutral Protamine Hagedorn Basal Insulin as Add-On to Metformin in Type 2 Diabetes in Sweden

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