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The Health Economic Value of Changes in Glycaemic Control, Weight and Rates of Hypoglycaemia in Type 1 Diabetes Mellitus

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  • Phil McEwan
  • Hayley Bennett
  • Jonathan Fellows
  • Jennifer Priaulx
  • Klas Bergenheim

Abstract

Aims: Therapy-related consequences of treatment for type 1 diabetes mellitus (T1DM), such as weight gain and hypoglycaemia, act as a barrier to attaining optimal glycaemic control, indirectly influencing the incidence of vascular complications and associated morbidity and mortality. This study quantifies the individual and combined contribution of changes in hypoglycaemia frequency, weight and HbA1c to predicted quality-adjusted life-years (QALYs) within a T1DM population. Materials and methods: We describe the Cardiff Type 1 Diabetes (CT1DM) Model, originally informed by the Diabetes Control and Complications Trial (DCCT) and updated with the Epidemiology of Diabetes Interventions and Complications (EDIC) study and Swedish National Diabetes Registry for microvascular and cardiovascular complications respectively. We report model validation results and the QALY impact of HbA1c, weight and hypoglycaemia changes. Results: Validation results demonstrated coefficients of determination for clinical endpoints of R2 = 0.863 (internal R2 = 0.999; external R2 = 0.823), costs R2 = 0.980 and QALYs R2 = 0.951. Achieving and maintaining a 1% HbA1c reduction was estimated to provide 0.61 additional discounted QALYs. Weight changes of ±1kg, ±2kg or ±3kg led to discounted QALY changes of ±0.03, ±0.07 and ±0.10 respectively, while modifying hypoglycaemia frequency by -10%, -20% or -30% resulted in changes of -0.05, -0.11 and -0.17. The differences in discounted costs, life-years and QALYs associated with HbA1c 6% versus 10% were -£19,037, 2.49 and 2.35 respectively. Conclusions: Using a model updated with contemporary epidemiological data, this study presents an outcome-focused perspective to assessing the health economic consequences of differing levels of glycaemic control in T1DM with and without weight and hypoglycaemia effects.

Suggested Citation

  • Phil McEwan & Hayley Bennett & Jonathan Fellows & Jennifer Priaulx & Klas Bergenheim, 2016. "The Health Economic Value of Changes in Glycaemic Control, Weight and Rates of Hypoglycaemia in Type 1 Diabetes Mellitus," PLOS ONE, Public Library of Science, vol. 11(9), pages 1-14, September.
  • Handle: RePEc:plo:pone00:0162441
    DOI: 10.1371/journal.pone.0162441
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    References listed on IDEAS

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    1. Tom Lung & Philip Clarke & Alison Hayes & Richard Stevens & Andrew Farmer, 2013. "Simulating Lifetime Outcomes Associated with Complications for People with Type 1 Diabetes," PharmacoEconomics, Springer, vol. 31(6), pages 509-518, June.
    2. Martin Henriksson & Ramandeep Jindal & Catarina Sternhufvud & Klas Bergenheim & Elisabeth Sörstadius & Michael Willis, 2016. "A Systematic Review of Cost-Effectiveness Models in Type 1 Diabetes Mellitus," PharmacoEconomics, Springer, vol. 34(6), pages 569-585, June.
    3. Adrian Bagust & Sophie Beale, 2005. "Modelling EuroQol health‐related utility values for diabetic complications from CODE‐2 data," Health Economics, John Wiley & Sons, Ltd., vol. 14(3), pages 217-230, March.
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