Understanding the inter‐relationship between improved glycaemic control, hypoglycaemia and weight change within a long‐term economic model

McEwan, P.; Evans, Marc; Kan, Hong; Bergenheim, Klas

doi:10.1111/j.1463-1326.2009.01184.x

Cited by 36 publications

(36 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Subsequently, this model represents a plausible approach to assess the value of improving glycaemic control, hypoglycaemia incidence and body weight in populations not reflective of the DCCT/EDIC study cohort, such as those over 60 years of age, or with a long duration of Type 1 diabetes. Furthermore, the impact of weight, hypoglycaemia and HbA 1c on predicted QALYs in this study are consistent with published analyses using the Cardiff Type 2 Diabetes Model 25; and the structure and performance of both Cardiff models have undergone rigorous scrutiny at several Mount Hood Diabetes Challenge Meetings 33, 34, 35.…”

Section: Discussionsupporting

confidence: 87%

“…Recent studies have reported the health economic value of improved disease management in Type 2 diabetes 25, and estimated the potential costs avoided that a modest HbA 1c reduction would achieve within the UK healthcare system 7. In the present analysis, we quantified the health economic burden of inadequate Type 1 diabetes management in the UK, and estimated the value associated with incremental HbA 1c improvements, fewer hypoglycaemic events and reduced BMI in people with Type 1 diabetes.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA_1c, weight and hypoglycaemic event incidence

et al. 2018

Self Cite

View full text Add to dashboard Cite

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 HbA1c, 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 HbA1c, 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 £20 000/QALY gained. Per‐person outputs were inflated to national levels using UK Type 1 diabetes prevalence estimates.ResultsModelled subjects with an HbA1c of 86 mmol/mol (10.0%) were associated with discounted lifetime per‐person costs of £23 795; £12 649 of which may be avoided by maintaining an HbA1c of 42 mmol/mol (6.0%). Combined with estimated QALY gains of 2.80, an HbA1c of 42 mmol/mol (6.0%) vs. 86 mmol/mol (10.0%) was associated with a £68 621 per‐person net monetary benefit. Over 1 year, unit reductions in BMI produced £120 per‐person net monetary benefit, and up to £197 for the avoidance of one non‐severe hypoglyceamic event.ConclusionsMaintained reductions in HbA1c 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.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA_1c, weight and hypoglycaemic event incidence

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…[1,2] Conversely, strict glycemic control may increase the risk of hypoglycemia [3,4] which, in some cases, may even offset the expected beneficial effects of good glycemic control. [5] Therefore, hypoglycemia may be an obstacle for good glycemic control and should be an important factor to consider when determining the optimal glycemic target during the selection of medications. This condition is not only observed in clinical practice and tends to develop more frequently in patients with type 1 diabetes and those being treated with insulin, [6] but also reported in patients taking oral hypoglycemic agents.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of severe hypoglycemia requiring medical assistance and neurological sequelae in patients with diabetes

Jeon

Kim

et al. 2016

Medicine

View full text Add to dashboard Cite

show abstract

“…A previously published and validated economic model, Cardiff Diabetes Model, was used in this study [49][50][51][52]. It is a patient level fixed-time increment, Monte Carlo micro simulation model designed to evaluate the long-term cost-effectiveness of comparable diabetes treatments (a "treatment" arm versus a "control" arm).…”

Section: Cost-effectiveness Modelmentioning

confidence: 99%

Cost-Effectiveness of Dapagliflozin Versus Acarbose as A Monotherapy in Type 2 Diabetes in China

2016

Value in Health

View full text Add to dashboard Cite

ObjectiveTo estimate the long-term cost-effectiveness of dapagliflozin versus acarbose as monotherapy in treatment-naïve patients with type 2 diabetes mellitus (T2DM) in China. MethodsThe Cardiff Diabetes Model, an economic model designed to evaluate the cost-effectiveness of comparator therapies in diabetes was used to simulate disease progression and estimate the long-term effect of treatments on patients. Systematic literature reviews, hospital surveys, meta-analysis and indirect treatment comparison were conducted to obtain model-required patient profiles, clinical data and costs. Health insurance costs (2015¥) were estimated over 40 years from a healthcare payer perspective. Univariate and probabilistic sensitivity analyses were performed. ResultsThe model predicted that dapagliflozin had lower incidences of cardiovascular events, hypoglycemia and mortality events, was associated with a mean incremental benefit of 0.25 quality-adjusted life-years (QALYs) and with a lower cost of ¥8,439 compared with acarbose. This resulted in a cost saving of ¥33,786 per QALY gained with dapagliflozin. Sensitivity analyses determined that the results are robust. ConclusionDapagliflozin is dominant compared with acarbose as monotherapy for Chinese T2DM patients, with a little QALY gain and lower costs. Dapagliflozin offers a well-tolerated and cost-effective alternative medication for treatment-naive patients in China, and may have a direct impact in reducing the disease burden of T2DM.

show abstract

Understanding the inter‐relationship between improved glycaemic control, hypoglycaemia and weight change within a long‐term economic model

Abstract: The results of this analysis quantify the QALY decrement that may result from adverse therapy effects. The beneficial effects of improved glycaemic control on QALYs may be offset by characteristic treatment-specific adverse effects, such as weight gain and hypoglycaemia frequency.

Cited by 36 publications

References 36 publications

Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA_1c, weight and hypoglycaemic event incidence

Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA_1c, weight and hypoglycaemic event incidence

Risk factors of severe hypoglycemia requiring medical assistance and neurological sequelae in patients with diabetes

Cost-Effectiveness of Dapagliflozin Versus Acarbose as A Monotherapy in Type 2 Diabetes in China

Contact Info

Product

Resources

About

Understanding the inter‐relationship between improved glycaemic control, hypoglycaemia and weight change within a long‐term economic model

Abstract: The results of this analysis quantify the QALY decrement that may result from adverse therapy effects. The beneficial effects of improved glycaemic control on QALYs may be offset by characteristic treatment-specific adverse effects, such as weight gain and hypoglycaemia frequency.

Cited by 36 publications

References 36 publications

Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA1c, weight and hypoglycaemic event incidence

Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA1c, weight and hypoglycaemic event incidence

Risk factors of severe hypoglycemia requiring medical assistance and neurological sequelae in patients with diabetes

Cost-Effectiveness of Dapagliflozin Versus Acarbose as A Monotherapy in Type 2 Diabetes in China

Contact Info

Product

Resources

About

Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA_1c, weight and hypoglycaemic event incidence

Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA_1c, weight and hypoglycaemic event incidence