Cost-effectiveness of interventions to prevent and control diabetes mellitus: a systematic review.
Cost-effectiveness of interventions to prevent and control diabetes mellitus: a systematic review.
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DOI：
10.2337/dc10-0843
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发表时间：
2010-08
期刊：
影响因子：
16.2
通讯作者：
Zhang X
中科院分区：
文献类型：
--
作者：
Li R;Zhang P;Barker LE;Chowdhury FM;Zhang X
综合预防和控制糖尿病及其并发症和合并症的干预措施的成本效益(CE)。我们对1985年1月至2008年5月发表的美国糖尿病协会(ADA)推荐的糖尿病CE干预的文献进行了系统的回顾。我们将关于行政长官干预的证据强度归类为强烈、支持或不确定。CES被归类为成本节约(以更低的成本获得更多的健康益处)、非常成本效益(每获得生命年或经质量调整的寿命年≤为25,000美元)、成本效益(每生命年25,001美元至50,000美元)、略微成本效益(每生命年或生命质量年50,001美元至100,000美元)或不具成本效益(每生命年或生命年100,000美元)。如果CE因实施干预的地点不同而不同，则按国家环境(美国或其他发达国家)单独报告干预的CE分类。成本是以2007年美元计算的。来自20个国家的56项研究符合纳入标准。ADA推荐的绝大多数干预措施都是具有成本效益的。我们发现强有力的证据表明，以下干预措施是节省成本或非常有效的：(I)节省成本--1)与标准高血压控制相比，使用血管紧张素转换酶抑制剂(ACEI)进行强化高血压控制；2)与不使用ACEI或ARB治疗相比，使用ACEI或血管紧张素受体拮抗剂(ARB)治疗预防终末期肾病(ESRD)；3)早期厄贝沙坦治疗(在微量白蛋白尿阶段)以预防ESRD；与较晚治疗(在大量白蛋白尿阶段)相比；4)与常规护理相比，全面足部护理以防止溃疡；5)与传统的1型糖尿病胰岛素疗法相比，用于糖尿病风险因素控制和早期发现并发症的多成分干预措施；以及6)用于糖尿病风险因素控制和早期发现并发症的多成分干预措施，与用于2型糖尿病患者的标准血糖控制方法相比。(Ii)非常具有成本效益--1)与标准生活方式建议相比，加强生活方式干预，在糖耐量受损的人群中预防2型糖尿病；2)在45岁至54岁的非裔美国人中普遍进行未诊断的2型糖尿病的机会性筛查；3)在新诊断的2型糖尿病患者中实施强化血糖控制研究，与传统的血糖控制相比较；4)他汀类药物用于二级预防心血管疾病的治疗与非他汀类药物治疗的比较；5)咨询和戒烟治疗与不咨询和治疗的比较；6)糖尿病视网膜病变的年度筛查和后续治疗与没有筛查的1型糖尿病患者相比；7)与不筛查相比，对2型糖尿病患者进行糖尿病视网膜病变的年度筛查和随后的治疗；以及8)与延期玻璃体切割术相比，立即进行玻璃体切除治疗糖尿病视网膜病变。许多旨在预防/控制糖尿病的干预措施都是节省成本或非常有成本效益的，并有强有力的证据支持。政策制定者应该考虑将这些干预放在更高的优先位置。
To synthesize the cost-effectiveness (CE) of interventions to prevent and control diabetes, its complications, and comorbidities. We conducted a systematic review of literature on the CE of diabetes interventions recommended by the American Diabetes Association (ADA) and published between January 1985 and May 2008. We categorized the strength of evidence about the CE of an intervention as strong, supportive, or uncertain. CEs were classified as cost saving (more health benefit at a lower cost), very cost-effective (≤$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001 to $50,000 per LYG or QALY), marginally cost-effective ($50,001 to $100,000 per LYG or QALY), or not cost-effective (>$100,000 per LYG or QALY). The CE classification of an intervention was reported separately by country setting (U.S. or other developed countries) if CE varied by where the intervention was implemented. Costs were measured in 2007 U.S. dollars. Fifty-six studies from 20 countries met the inclusion criteria. A large majority of the ADA recommended interventions are cost-effective. We found strong evidence to classify the following interventions as cost saving or very cost-effective: (I) Cost saving— 1) ACE inhibitor (ACEI) therapy for intensive hypertension control compared with standard hypertension control; 2) ACEI or angiotensin receptor blocker (ARB) therapy to prevent end-stage renal disease (ESRD) compared with no ACEI or ARB treatment; 3) early irbesartan therapy (at the microalbuminuria stage) to prevent ESRD compared with later treatment (at the macroalbuminuria stage); 4) comprehensive foot care to prevent ulcers compared with usual care; 5) multi-component interventions for diabetic risk factor control and early detection of complications compared with conventional insulin therapy for persons with type 1 diabetes; and 6) multi-component interventions for diabetic risk factor control and early detection of complications compared with standard glycemic control for persons with type 2 diabetes. (II) Very cost-effective— 1) intensive lifestyle interventions to prevent type 2 diabetes among persons with impaired glucose tolerance compared with standard lifestyle recommendations; 2) universal opportunistic screening for undiagnosed type 2 diabetes in African Americans between 45 and 54 years old; 3) intensive glycemic control as implemented in the UK Prospective Diabetes Study in persons with newly diagnosed type 2 diabetes compared with conventional glycemic control; 4) statin therapy for secondary prevention of cardiovascular disease compared with no statin therapy; 5) counseling and treatment for smoking cessation compared with no counseling and treatment; 6) annual screening for diabetic retinopathy and ensuing treatment in persons with type 1 diabetes compared with no screening; 7) annual screening for diabetic retinopathy and ensuing treatment in persons with type 2 diabetes compared with no screening; and 8) immediate vitrectomy to treat diabetic retinopathy compared with deferred vitrectomy. Many interventions intended to prevent/control diabetes are cost saving or very cost-effective and supported by strong evidence. Policy makers should consider giving these interventions a higher priority.
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影响因子：
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作者：
BORCHJOHNSEN, K;WENZEL, H;MOGENSEN, CE
通讯作者：
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3.9
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