Requisite models for strategic commissioning: the example of type 1 diabetes

Abstract

A developing emphasis of health care reforms has been creating organisations with responsibilities for strategic commissioning of services for defined populations. Such organisations must set priorities in aiming to meet their populations' needs subject to a budget constraint. This requires estimates of the health benefits and costs of different interventions for their populations. This paper outlines a framework that does this and shows how this requires modelling to produce estimates in a way that is transparent to commissioners, of requisite complexity to produce sound estimates for priority setting using routinely available data. The example illustrated in this paper is an intervention that would improve glucose control in the English population with type 1 diabetes. It takes many years for a change in glucose management to deliver maximum benefits; hence the intervention is not good value-for-money in the short run. We aim to give a more strategic view of the costs and benefits modelling costs and benefits in a steady-state model which suggests that the intervention is good value-for-money in the long run.

Economic Modelling of Chronic Kidney Disease: A Systematic Literature Review to Inform Conceptual Model Design

“…The second approach exclusively modelled the progression of nephropathy in diabetic patients through albuminuria health states, without modelling diabetes progression or HbA 1c . Twelve (25%) were models of type 1 diabetes mellitus (T1DM) [74, 79–89], 22 (46%) were models of type 2 diabetes mellitus (T2DM) [90–111] and seven (16%) were models of both T1DM and T2DM [112–117]. The remaining models evaluated either diabetes with hypertension [118–120], pre-diabetes [121, 122], or diabetes with more advanced kidney disease [123, 124].…”

Cost-effectiveness of Initiating an Insulin Pump in T1D Adults Using Continuous Glucose Monitoring Compared with Multiple Daily Insulin Injections: The DIAMOND Randomized Trial

“…23 The Sheffield model simulates the patient-level natural history of T1D over the projected lifetime of patients, including progression through major microvascular and macrovascular complications, as well as short-term complications (hypo- and hyperglycemia) and their associated costs and health utilities. Among the existing 15 T1D simulation models, 22,24–37 we selected the Sheffield model based on the following features: the model was constructed solely using T1D studies and trials; it includes HbA1c, a risk factor, in most risk equations; it was validated against major T1D trial studies; and it is completely transparent and hence reproducible.…”

Rationing in the fiscal ice age

“…Accordingly this PCT, like many others, uses multi-criteria decision analysis (MCDA). This involves scoring candidates for investment on 11 criteria -ranging from the magnitude of the benefit to impact on health inequality -using a five-point scale (see also Airoldi and Bevan, 2010). Other techniques are on offer and in use, notably Programme Budget and Marginal Analysis (PBMA), designed to create an economic framework within which account can be taken of equity and other criteria (Donaldson et al, 2008;Wilson et al, 2008).…”