Outline of a diabetes disease management model: principles and applications

Palmer, Andrew J.; Brandt, Arno; Gozzoli, Valerio; Weiß, Christian; Stock, Harald; Wenzel, Helmut

doi:10.1016/s0168-8227(00)00216-3

Cited by 32 publications

(22 citation statements)

References 10 publications

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“…Variations in total average cost per patient between these economic studies are partly due to differences between inclusion/exclusion criteria, cost assessment, treatments and healthcare systems. The financial burden of allergic asthma and/or SAR from the TPPs perspective is further comparable to other chronic diseases, such as diabetes mellitus type 2, in Germany [20,21]. SCHULENBURG et al [10] collected data from 216 German patients.…”

Section: Discussionmentioning

confidence: 99%

Cost of illness of atopic asthma and seasonal allergic rhinitis in Germany: 1‐yr retrospective study

Schramm¹,

Ehlken²,

Smala³

et al. 2003

Eur Respir J

129

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The purpose of this study was to evaluate the cost of illness of moderateto-severe atopic asthma and/or seasonal allergic rhinitis (SAR) in Germany from the perspective of third-party payers (TPP) and patients.Five-hundred patients (276 children/adolescents) with moderate-to-severe asthma and/ or SAR were included in this cross-sectional study. Information was collected using a specific patient questionnaire and the abstraction of patient records.Overall, annual costs per patient increased with the severity of atopic asthma and if it was associated with SAR. The average annual cost of SAR was J1,089 per child/ adolescent and J1,543 per adult. Annual costs of severe asthma plus SAR increased to J7,928 per child/adolescent and to J9,287 per adult. For TPPs, the main cost drivers were medication, hospitalisation, and rehabilitation. The most significant costs for patients were household modifications. For children/adolescents, 60-78% of the expenditures were direct costs, while in adults, 58% of expenditures were indirect costs. It was also observed that patients with moderate and severe asthma used inhaled corticosteroids less frequently than recommended by treatment guidelines.In summary, the total cost for patients increases with the severity of atopic asthma and/or seasonal allergic rhinitis and indirect costs represent a large proportion of the total cost.

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Section: Discussionmentioning

confidence: 99%

Cost of illness of atopic asthma and seasonal allergic rhinitis in Germany: 1‐yr retrospective study

Schramm¹,

Ehlken²,

Smala³

et al. 2003

Eur Respir J

129

View full text Add to dashboard Cite

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“…They can also be used to estimate future healthcare costs of patients with Type 2 diabetes, but their main purpose is to estimate the cost-effectiveness of different disease management strategies, especially when evidence of the impact of interventions on surrogate endpoints is limited, or where evidence from clinical trials has to be extrapolated over patients' lifetimes. Currently, there are at least five simulation models being used in these ways [1,2,3,4,5].…”

Section: Introductionmentioning

confidence: 99%

A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68)

et al. 2004

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Aims/hypothesis. The aim of this study was to develop a simulation model for Type 2 diabetes that can be used to estimate the likely occurrence of major diabetes-related complications over a lifetime, in order to calculate health economic outcomes such as qualityadjusted life expectancy. Methods. Equations for forecasting the occurrence of seven diabetes-related complications and death were estimated using data on 3642 patients from the United Kingdom Prospective Diabetes Study (UKPDS). After examining the internal validity, the UKPDS Outcomes Model was used to simulate the mean difference in expected quality-adjusted life years between the UKPDS regimens of intensive and conventional blood glucose control. Results. The model's forecasts fell within the 95% confidence interval for the occurrence of observed events during the UKPDS follow-up period. When the model was used to simulate event history over patients' lifetimes, those treated with a regimen of conventional glucose control could expect 16.35 undiscounted quality-adjusted life years, and those receiving treatment with intensive glucose control could expect 16.62 quality-adjusted life years, a difference of 0.27 (95% CI: −0.48 to 1.03). Conclusions/interpretations. The UKPDS OutcomesModel is able to simulate event histories that closely match observed outcomes in the UKPDS and that can be extrapolated over patients' lifetimes. Its validity in estimating outcomes in other groups of patients, however, remains to be evaluated. The model allows simulation of a range of long-term outcomes, which should assist in informing future economic evaluations of interventions in Type 2 diabetes. The centres of the UKPDS are listed at the end of the paper Conflict of interest. Several authors (as indicated above) are employed by the University of Oxford. This paper describes and places in the public domain a simulation model that we have called the UKPDS Outcomes Model. All of the information necessary to reproduce the UKPDS Outcomes Model is provided in this article, but it is conceivable that a future user with a commercial interest in the UKPDS Outcomes Model might prefer to use the software already created by University programmers. Depending on the nature of the proposed use of the UKPDS Outcomes Model, the University of Oxford might charge a fee in this case.

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“…Our model differs from previously published models (3)(4)(5)(6)(7) in that it predicts the onset and progression of type 2 diabetes; incorporates features to assess the impact of medical screening, diagnosis, and treatment compliance on outcomes; and integrates new data on health utilities and direct medical costs.…”

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confidence: 99%

A Computer Simulation Model of Diabetes Progression, Quality of Life, and Cost

et al. 2005

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OBJECTIVE -To develop and validate a comprehensive computer simulation model to assess the impact of screening, prevention, and treatment strategies on type 2 diabetes and its complications, comorbidities, quality of life, and cost.RESEARCH DESIGN AND METHODS -The incidence of type 2 diabetes and its complications and comorbidities were derived from population-based epidemiologic studies and randomized, controlled clinical trials. Health utility scores were derived for patients with type 2 diabetes using the Quality of Well Being-Self-Administered. Direct medical costs were derived for managed care patients with type 2 diabetes using paid insurance claims. Monte Carlo techniques were used to implement a semi-Markov model. Performance of the model was assessed using baseline and 4-and 10-year follow-up data from the older-onset diabetic population studied in the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR).RESULTS -Applying the model to the baseline WESDR population with type 2 diabetes, we predicted mortality to be 51% at 10 years. The prevalences of stroke and myocardial infarction were predicted to be 18 and 19% at 10 years. The prevalences of nonproliferative diabetic retinopathy, proliferative retinopathy, and macular edema were predicted to be 45, 16, and 18%, respectively; the prevalences of microalbuminuria, proteinuria, and end-stage renal disease were predicted to be 19, 39, and 3%, respectively; and the prevalences of clinical neuropathy and amputation were predicted to be 52 and 5%, respectively, at 10 years. Over 10 years, average undiscounted total direct medical costs were estimated to be $53,000 per person. Among survivors, the average utility score was estimated to be 0.56 at 10 years.CONCLUSIONS -Our computer simulation model accurately predicted survival and the cardiovascular, microvascular, and neuropathic complications observed in the WESDR cohort with type 2 diabetes over 10 years. The model can be used to predict the progression of diabetes and its complications, comorbidities, quality of life, and cost and to assess the relative effectiveness, cost-effectiveness, and cost-utility of alternative strategies for the prevention and treatment of type 2 diabetes. Diabetes Care 28:2856 -2863, 2005T ype 2 diabetes is associated with long-term complications that ultimately cause more cases of adult blindness, renal failure, and amputation than any other disease in the U.S. (1). In addition, people with type 2 diabetes are at increased risk for stroke and myocardial infarction, and mortality rates for people with type 2 diabetes are about twice those for people without diabetes (2). Because of the high morbidity, mortality, and cost associated with type 2 diabetes, there has been great interest in identifying strategies for the prevention and treatment of type 2 diabetes and in assessing the impact of those strategies on survival, disease progression, complications, comorbidities, quality of life, and cost.To address these issues, we have developed a comprehensive model that synthe...

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Outline of a diabetes disease management model: principles and applications

Cited by 32 publications

References 10 publications

Cost of illness of atopic asthma and seasonal allergic rhinitis in Germany: 1‐yr retrospective study

Cost of illness of atopic asthma and seasonal allergic rhinitis in Germany: 1‐yr retrospective study

A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68)

A Computer Simulation Model of Diabetes Progression, Quality of Life, and Cost

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