Cost-effectiveness of intensified versus conventional multifactorial intervention in type 2 diabetes: results and projections from the Steno-2 study.
Cost-effectiveness of intensified versus conventional multifactorial intervention in type 2 diabetes: results and projections from the Steno-2 study.
复制标题
2型糖尿病中加强与常规多因素干预的成本效益：Steno-2研究的结果和预测。
DOI：
10.2337/dc07-2452
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发表时间：
2008-08
期刊：
影响因子：
16.2
通讯作者：
Pedersen, Oluf
中科院分区：
文献类型：
--
作者：
Gaede, Peter;Valentine, William J.;Palmer, Andrew J.;Tucker, Daniel M. D.;Lammert, Morten;Parving, Hans-Henrik;Pedersen, Oluf
目的——评估 Steno-2 研究中针对 2 型糖尿病和微量白蛋白尿患者应用的 8 年强化治疗与常规治疗的成本效益。研究设计和方法——开发了马尔可夫模型来合并来自 Steno-2 的事件和风险数据，并考虑丹麦特定的成本，以预测预期寿命、质量调整预期寿命 (QALE) 以及以 2005 年欧元表示的终生直接医疗费用。临床和成本结果在患者一生中进行预测，并每年折扣 3%。进行了敏感性分析。结果——与传统治疗相比，强化治疗与预期寿命、QALE 和终生成本的增加相关。强化治疗组的平均±标准差未折现预期寿命为 18.1 ± 7.9 年，常规治疗组为 16.2 ± 7.3 年（相差 1.9 年）。强化治疗的折现预期寿命为 13.4 ± 4.8 年，常规治疗的折现预期寿命为 12.4 ± 4.5 年。强化治疗和常规治疗的终生费用（折扣后）分别为 45,521 ± 19,697 欧元和 41,319 ± 27,500 欧元（相差 4,202 欧元）。强化治疗的费用增加是由于药房和咨询费用增加。与传统治疗（8.6 ± 2.7 QALY）相比，强化治疗（10.2 ± 3.6 QALY）的折现质量调整生命年（QALY）高出 1.66 个质量调整生命年（QALY），每增加一个 QALY，成本效益比将增加 2,538 欧元。这被认为是保守的估计，因为核算仿制药处方和捕获间接成本将进一步有利于强化治疗。结论——从丹麦医疗保健支付者的角度来看，强化治疗比传统治疗更具成本效益。假设双臂患者均在初级保健机构接受治疗，强化治疗将成为主导（节省成本和挽救生命）。
OBJECTIVE—To assess the cost-effectiveness of intensive versus conventional therapy for 8 years as applied in the Steno-2 study in patients with type 2 diabetes and microalbuminuria. RESEARCH DESIGN AND METHODS—A Markov model was developed to incorporate event and risk data from Steno-2 and account Danish-specific costs to project life expectancy, quality-adjusted life expectancy (QALE), and lifetime direct medical costs expressed in year 2005 Euros. Clinical and cost outcomes were projected over patient lifetimes and discounted at 3% annually. Sensitivity analyses were performed. RESULTS—Intensive treatment was associated with increased life expectancy, QALE, and lifetime costs compared with conventional treatment. Mean ± SD undiscounted life expectancy was 18.1 ± 7.9 years with intensive treatment and 16.2 ± 7.3 years with conventional treatment (difference 1.9 years). Discounted life expectancy was 13.4 ± 4.8 years with intensive treatment and 12.4 ± 4.5 years with conventional treatment. Lifetime costs (discounted) for intensive and conventional treatment were €45,521 ± 19,697 and €41,319 ± 27,500, respectively (difference €4,202). Increased costs with intensive treatment were due to increased pharmacy and consultation costs. Discounted QALE was 1.66 quality-adjusted life-years (QALYs) higher for intensive (10.2 ± 3.6 QALYs) versus conventional (8.6 ± 2.7 QALYs) treatment, resulting in an incremental cost-effectiveness ratio of €2,538 per QALY gained. This is considered a conservative estimate because accounting prescription of generic drugs and capturing indirect costs would further favor intensified therapy. CONCLUSIONS—From a health care payer perspective in Denmark, intensive therapy was more cost-effective than conventional treatment. Assuming that patients in both arms were treated in a primary care setting, intensive therapy became dominant (cost- and lifesaving).
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影响因子：
5
作者：
Leibson, CL;OBrien, PC;Melton, LJ
通讯作者：
Melton, LJ
影响因子：
3.2
作者：
Scuffham, PA;Chaplin, S
通讯作者：
Chaplin, S
影响因子：
8.2
作者：
Jönsson, B;Cook, JR;Pedersen, TR
通讯作者：
Pedersen, TR
影响因子：
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作者：
Kothari, V;Stevens, RJ;Holman, RR
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Holman, RR
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作者：
Clarke, P;Gray, A;Holman, R
通讯作者：
Holman, R