Cost-effectiveness of Interventions to Manage Diabetes: Has the Evidence Changed Since 2008?
Cost-effectiveness of Interventions to Manage Diabetes: Has the Evidence Changed Since 2008?
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DOI：
10.2337/dci20-0017
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发表时间：
2020-07-01
期刊：
影响因子：
16.2
通讯作者：
Zhang, Ping
中科院分区：
文献类型：
--
作者：
Siegel, Karen R.;Ali, Mohammed K.;Zhang, Ping
目的综合糖尿病及其并发症和合并症干预措施的成本效益（CE）的最新证据。研究设计和方法我们对来自高收入国家的研究进行了系统的文献综述，这些研究评估了美国糖尿病协会（ADA）推荐的糖尿病管理干预措施的CE，并在2008年6月至2017年7月期间以英语发表。我们还纳入了1985-2008年期间的既往CE审查研究。我们根据证据强度（强有力、支持性或不确定）和CE水平对干预措施进行分类：节省成本（以较低成本获得更多健康益处）、非常具有成本效益（每LYG或QALY 10万美元）。成本以2017年美元计算。结果73项新研究符合我们的纳入标准。这些研究与之前综述中的49项研究相结合，在1985-2017年期间产生了122项研究。ADA建议的绝大多数干预措施仍然具有成本效益。具体来说，我们发现了强有力的证据，证明以下ADA推荐的干预措施可以节省成本或非常具有成本效益：在成本节省类别中，1）与标准高血压管理相比，ACE抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）治疗用于强化高血压管理，2）与无ACEI/ARB治疗相比，ACEI/ARB治疗预防蛋白尿患者的慢性肾病和/或终末期肾病，3）综合足部护理和患者教育，以预防和治疗中度/高度足部溃疡风险的足部溃疡，4）糖尿病视网膜病变筛查的远程医疗与办公室筛查的比较，以及5）2型糖尿病（T2 D）和肥胖（BMI >= 30 kg/m2）个体的减肥手术与不手术的比较。在非常具有成本效益的类别是1）强化血糖管理（目标A1 C = 50岁，和11）抑郁症的合作护理相比，通常care.CONCLUSIONS补充专业的治疗建议，我们的系统评价提供了一个更新的了解的潜在价值的干预措施，以管理糖尿病及其并发症，可以帮助临床医生和支付者在优先干预措施和医疗保健资源。
OBJECTIVE To synthesize updated evidence on the cost-effectiveness (CE) of interventions to manage diabetes, its complications, and comorbidities. RESEARCH DESIGN AND METHODS We conducted a systematic literature review of studies from high-income countries evaluating the CE of diabetes management interventions recommended by the American Diabetes Association (ADA) and published in English between June 2008 and July 2017. We also incorporated studies from a previous CE review from the period 1985-2008. We classified the interventions based on their strength of evidence (strong, supportive, or uncertain) and levels of CE: cost-saving (more health benefit at a lower cost), very cost-effective ($100,000 per LYG or QALY). Costs were measured in 2017 U.S. dollars. RESULTS Seventy-three new studies met our inclusion criteria. These were combined with 49 studies from the previous review to yield 122 studies over the period 1985-2017. A large majority of the ADA-recommended interventions remain cost-effective. Specifically, we found strong evidence that the following ADA-recommended interventions are cost-saving or very cost-effective: In the cost-saving category are1) ACE inhibitor (ACEI)/angiotensin receptor blocker (ARB) therapy for intensive hypertension management compared with standard hypertension management,2) ACEI/ARB therapy to prevent chronic kidney disease and/or end-stage renal disease in people with albuminuria compared with no ACEI/ARB therapy,3) comprehensive foot care and patient education to prevent and treat foot ulcers among those at moderate/high risk of developing foot ulcers,4) telemedicine for diabetic retinopathy screening compared with office screening, and5) bariatric surgery compared with no surgery for individuals with type 2 diabetes (T2D) and obesity (BMI >= 30 kg/m(2)). In the very cost-effective category are1) intensive glycemic management (targeting A1C = 50 years, and11) collaborative care for depression compared with usual care.CONCLUSIONS Complementing professional treatment recommendations, our systematic review provides an updated understanding of the potential value of interventions to manage diabetes and its complications and can assist clinicians and payers in prioritizing interventions and health care resources.