Assessing the cost-effectiveness of drug and lifestyle intervention following opportunistic screening for pre-diabetes in primary care
Assessing the cost-effectiveness of drug and lifestyle intervention following opportunistic screening for pre-diabetes in primary care
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DOI：
10.1007/s00125-010-1661-8
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发表时间：
2010-05-01
期刊：
影响因子：
8.2
通讯作者：
Vos, T.
中科院分区：
文献类型：
--
作者：
Bertram, M. Y.;Lim, S. S.;Vos, T.
这项研究旨在评估糖尿病前期筛查计划的成本效益，该计划随后通过药物干预(阿卡波糖、二甲双胍、奥利司他)或生活方式干预(饮食、运动、饮食和锻炼)来预防或减缓高危人群糖尿病的发病。为了近似澳大利亚人群中糖尿病前期患者的经历，我们使用了微观模拟方法，跟踪糖尿病、心血管疾病和肾功能衰竭的患者进展。该模型将通过每项干预的机会性筛查计划确定的患者的成本和残疾调整后的寿命年与具有代表性的当前做法的“什么都不做”情景进行比较。假设生活方式改变的效果将以每年10%的速度衰减，而药物干预的效果在整个使用过程中保持不变。最具成本效益的干预选择是饮食和运动相结合，每避免一个残疾调整生命年(DALY)的成本-效果比为22,500澳元，以及成本-效果比为每个DALY避免的21,500澳元。一种干预措施加到另一种干预措施上是不划算的。筛查糖尿病前期，然后节食和锻炼，或二甲双胍治疗是划算的，应该考虑纳入到当前的实践中。提供这种生活方式改变干预措施所需的营养师和运动生理学家的数量将需要增加，以适当支持干预措施。
This study aims to evaluate the cost-effectiveness of a screening programme for pre-diabetes, which was followed up by treatment with pharmaceutical interventions (acarbose, metformin, orlistat) or lifestyle interventions (diet, exercise, diet and exercise) in order to prevent or slow the onset of diabetes in those at high risk.To approximate the experience of individuals with pre-diabetes in the Australian population, we used a microsimulation approach, following patient progression through diabetes, cardiovascular disease and renal failure. The model compares costs and disability-adjusted life years lived in people identified through an opportunistic screening programme for each intervention compared with a 'do nothing' scenario, which is representative of current practice. It is assumed that the effect of a lifestyle change will decay by 10% per year, while the effect of a pharmaceutical intervention remains constant throughout use.The most cost-effective intervention options are diet and exercise combined, with a cost-effectiveness ratio of AUD 22,500 per disability-adjusted life year (DALY) averted, and metformin with a cost-effectiveness ratio of AUD 21,500 per DALY averted. The incremental addition of one intervention to the other is not cost-effective.Screening for pre-diabetes followed by diet and exercise, or metformin treatment is cost-effective and should be considered for incorporation into current practice. The number of dietitians and exercise physiologists needed to deliver such lifestyle change interventions will need to be increased to appropriately support the intervention.