Model of Complications of NIDDM .2. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia
Model of Complications of NIDDM .2. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia
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DOI：
10.2337/diacare.20.5.735
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发表时间：
1997-05-01
期刊：
影响因子：
16.2
通讯作者：
Harris, M
中科院分区：
文献类型：
--
作者：
Eastman, RC;Javitt, JC;Harris, M
目的-分析以降血糖为目标治疗NIDDM的健康效益和经济学。研究设计和方法-采用基于NIDDM发病率的模拟模型。使用糖尿病控制和并发症试验的风险梯度调整并发症的风险率。治疗费用是根据国家调查数据和临床试验估算的。增量成本和效益以现值美元（3%贴现率）表示。生活质量的生活年进行调整，产生质量调整的生活年（QALs）。结果-NIDDM的综合治疗，保持HbA（1c）值为7.2%，预计将减少失明，终末期肾病，下肢截肢的累积发病率分别为72%，87%和67%。心血管疾病风险增加3%（假设治疗心血管疾病没有效果）。预期寿命增加了1.39岁。治疗高血糖症的费用几乎增加了一倍，但并发症费用的减少部分抵消了这一增加。估计增量成本/获得的质量调整生命年为16，002美元。治疗是更符合成本效益的那些较长的血糖暴露（早期发病的糖尿病），少数民族，和那些具有较高的HbA（1C）下standardcare.CONCLUSIONS -治疗NIDDM的目标是正常的增量有效性估计是类似于16,000美元/QALY获得，这是在范围内的干预措施，通常被认为是符合成本效益的。
OBJECTIVE - To analyze the health benefits and economics of treating NIDDM with the goal of normoglycemia.RESEARCH DESIGN AND METHODS - Incidence-based simulation model of NIDDM was used. Hazard rates for complications were adjusted for glycemia using risk gradients from the Diabetes Control and Complications Trial. Treatment costs were estimated from national survey data and clinical trials. Incremental costs and benefits were expressed in present value dollars (3% discount rate). Life-years were adjusted for quality of life, yielding quality-adjusted life-years (QALYs).RESULTS - Comprehensive treatment of NIDDM that maintains an HbA(1c) value of 7.2% is predicted to reduce the cumulative incidence of blindness, end-stage renal disease, and lower-extremity amputation by 72, 87, and 67%, respectively. Cardiovascular disease risk increased by 3% (no effect of treating glycemia is assumed). Life expectancy increased 1.39 years. The cost of treating hyperglycemia increased by almost twofold, which is partially offset by reductions in the cost of complications. The estimated incremental cost/QALY gained is $16,002. Treatment is more cost-effective for those with longer glycemic exposure (earlier onset of diabetes), minorities, and those with higher HbA(1c) under standard care.CONCLUSIONS - The incremental effectiveness of treating NIDDM with the goal of normoglycemia is estimated to be similar to$16,000/QALY gained, which is in the range of interventions that are generally considered cost-effective.