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How Consistent is the Relationship between Improved Glucose Control and Modelled Health Outcomes for People with Type 2 Diabetes Mellitus? a Systematic Review

Author

Listed:
  • Xinyang Hua

    (University of Melbourne)

  • Thomas Wai-Chun Lung

    (University of Melbourne
    University of Sydney)

  • Andrew Palmer

    (University of Tasmania)

  • Lei Si

    (University of Tasmania)

  • William H. Herman

    (University of Michigan)

  • Philip Clarke

    (University of Melbourne)

Abstract

Background There are an increasing number of studies using simulation models to conduct cost-effectiveness analyses for type 2 diabetes mellitus. Objective To evaluate the relationship between improvements in glycosylated haemoglobin (HbA1c) and simulated health outcomes in type 2 diabetes cost-effectiveness studies. Methods A systematic review was conducted on MEDLINE and EMBASE to collect cost-effectiveness studies using type 2 diabetes simulation models that reported modelled health outcomes of blood glucose-related interventions in terms of quality-adjusted life-years (QALYs) or life expectancy (LE). The data extracted included information used to characterise the study cohort, the intervention’s treatment effects on risk factors and model outcomes. Linear regressions were used to test the relationship between the difference in HbA1c (∆HbA1c) and incremental QALYs (∆QALYs) or LE (∆LE) of intervention and control groups. The ratio between the ∆QALYs and ∆LE was calculated and a scatterplot between the ratio and ∆HbA1c was used to explore the relationship between these two. Results Seventy-six studies were included in this research, contributing to 124 pair of comparators. The pooled regressions indicated that the marginal effect of a 1% HbA1c decrease in intervention resulted in an increase in life-time QALYs and LE of 0.371 (95% confidence interval 0.286–0.456) and 0.642 (95% CI 0.494–0.790), respectively. No evidence of heterogeneity between models was found. An inverse exponential relationship was found and fitted between the ratio (∆QALY/∆LE) and ∆HbA1c. Conclusion There is a consistent relationship between ∆HbA1c and ∆QALYs or ∆LE in cost-effectiveness analyses using type 2 diabetes simulation models. This relationship can be used as a diagnostic tool for decision makers.

Suggested Citation

  • Xinyang Hua & Thomas Wai-Chun Lung & Andrew Palmer & Lei Si & William H. Herman & Philip Clarke, 2017. "How Consistent is the Relationship between Improved Glucose Control and Modelled Health Outcomes for People with Type 2 Diabetes Mellitus? a Systematic Review," PharmacoEconomics, Springer, vol. 35(3), pages 319-329, March.
    • Handle: RePEc:spr:pharme:v:35:y:2017:i:3:d:10.1007_s40273-016-0466-0
    DOI: 10.1007/s40273-016-0466-0
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    References listed on IDEAS

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    1. Sandra Tunis & Luc Sauriol & Michael Minshall, 2010. "Cost effectiveness of insulin glargine plus oral antidiabetes drugs compared with premixed insulin alone in patients with type 2 diabetes mellitus in Canada," Applied Health Economics and Health Policy, Springer, vol. 8(4), pages 267-280, July.
    2. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement," PharmacoEconomics, Springer, vol. 31(5), pages 361-367, May.
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    4. Jorge Elgart & Joaquin Caporale & Lorena Gonzalez & Eleonora Aiello & Maximiliano Waschbusch & Juan Gagliardino, 2013. "Treatment of type 2 diabetes with saxagliptin: a pharmacoeconomic evaluation in Argentina," Health Economics Review, Springer, vol. 3(1), pages 1-9, December.
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