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Baishnab S, Jaura RS, Sharma S, Garg H, Singh TG. Pharmacoeconomic Aspects of Diabetes Mellitus: Outcomes and Analysis of Health Benefits Approach. Curr Diabetes Rev 2024; 20:12-22. [PMID: 37842896 DOI: 10.2174/0115733998246567230924134603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/18/2023] [Accepted: 08/25/2023] [Indexed: 10/17/2023]
Abstract
Pharmacoeconomics is an important tool for investigating and restructuring healthcare policies. In India, recent statistical studies have shown that the number of diabetic patients is rapidly increasing in the rural, middle and upper-class settings. The aim of this review is to call attention towards the need to carry out pharmacoeconomic studies for diabetes mellitus and highlight the outcome of these studies on healthcare. A well-structured literature search from PubMed, Embase, Springer, ScienceDirect, and Cochrane was done. Studies that evaluated the cost-effectiveness of various anti-diabetic agents for type 2 diabetes were eligible for inclusion in the analysis and review. Two independent reviewers sequentially assessed the titles, abstracts, and full articles to select studies that met the predetermined inclusion and exclusion criteria for data abstraction. Any discrepancies between the reviewers were resolved through consensus. By employing search terms such as pharmacoeconomics, diabetes mellitus, cost-effective analysis, cost minimization analysis, cost-utility analysis, and cost-benefit analysis, a total of 194 papers were gathered. Out of these, 110 papers were selected as they aligned with the defined search criteria and underwent the removal of duplicate entries. This review outlined four basic pharmacoeconomic studies carried out on diabetes mellitus. It gave a direction that early detection, patient counseling, personalized medication, appropriate screening intervals, and early start of pharmacotherapy proved to be a cost-effective as well as health benefits approach.
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Affiliation(s)
- Suman Baishnab
- Department of Pharmacy Practice, Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Ravinder Singh Jaura
- Department of Pharmacy Practice, Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Saksham Sharma
- Department of Pharmacy Practice, Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Honey Garg
- Department of Pharmacy Practice, Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Thakur Gurjeet Singh
- Department of Pharmacy Practice, Chitkara College of Pharmacy, Chitkara University, Punjab, India
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Shen X, Yang L, Gu X, Liu YY, Jiang L. Geriatric Nutrition Risk Index as a predictor of cardiovascular and all-cause mortality in older Americans with diabetes. Diabetol Metab Syndr 2023; 15:89. [PMID: 37127636 PMCID: PMC10152715 DOI: 10.1186/s13098-023-01060-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND AND AIMS Few studies have examined the relationship between malnutrition, as defined by the Geriatric Nutrition Risk Index (GNRI), and all-cause mortality and cardiovascular mortality events, particularly in persons with diabetes. The study aimed at the association between GNRI and all-cause mortality and cardiovascular mortality in older Americans with diabetes. METHODS Data from this retrospective study were obtained from the National Health and Nutrition Examination (NHANES) 1999-2016. Using data from The NHANES Public-Use Linked Mortality Files to assess all-cause mortality (ACM) and cardiovascular mortality (CVM). After excluding participants younger than 60 years and without diabetes, and with missing follow-up data, 4400 cases were left in this study. Persons with diabetes were divided by GNRI into 3 groups: GNRI ≥ 98; 92 ≤ GNRI < 98; and GNRI < 92; (No; Low; Moderate/Severe (M/S) group). We used Cox proportional hazard regression model to explore the predictive role of GNRI on ACM and CVM in elderly persons with diabetes. Restricted cubic splines to investigate the existence of a dose-response linear relationship between them. RESULT During a median follow-up period of 89 months, a total of 538 (12.23%) cardiovascular deaths occurred and 1890 (42.95%) all-cause deaths occurred. Multifactorial COX regression analysis showed all-cause mortality (hazard ratio [HR]: 2.58, 95% CI: 1.672-3.994, p < 0.001) and cardiovascular mortality (HR: 2.29, 95% CI: 1.063-4.936, p = 0.034) associated with M/S group risk of malnutrition in GNRI compared to no group. A negative association between GNRI and all-cause mortality was observed across gender and ethnicity. However, the same negative association between GNRI and cardiovascular mortality was observed only for males (HR:0.94, 95% CI:0.905-0.974, p < 0.001) and other races (HR:0.92, 95% CI:0.861-0.976, p = 0.007). And there was no significant correlation between low malnutrition and cardiovascular mortality (p = 0.076). Restricted cubic splines showed a nonlinear relationship between GNRI and all-cause mortality and cardiovascular mortality (non-linear p < 0.001, non-linear p = 0.019). CONCLUSIONS Lower GNRI levels are associated with mortality in older patients with diabetes. GNRI may be a predictor of all-cause mortality and cardiovascular mortality risk in older patients with diabetes.
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Affiliation(s)
- Xia Shen
- Department of Nursing, Wuxi Medical College, Jiangnan University, 1800 Li Hu Avenue, Wuxi, 214062, China
| | - Long Yang
- College of Pediatrics, Xinjiang Medical University, Urumqi, China, 393 Xin Yi Road, Urumqi, 830054, China
| | - Xue Gu
- Department of Nursing, Wuxi Medical College, Jiangnan University, 1800 Li Hu Avenue, Wuxi, 214062, China
| | - Yuan-Yuan Liu
- Department of Nursing, Wuxi Medical College, Jiangnan University, 1800 Li Hu Avenue, Wuxi, 214062, China
| | - Lei Jiang
- Department of Radiology, The Convalescent Hospital of East China, No.67 Da Ji Shan, Wuxi, 214065, China.
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Barbosa A, Whiting S, Ding D, Brito J, Mendes R. Economic evaluation of physical activity interventions for type 2 diabetes management: a systematic review. Eur J Public Health 2022; 32:i56-i66. [PMID: 36031821 PMCID: PMC9421413 DOI: 10.1093/eurpub/ckac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Economic evaluation of physical activity interventions has become an important area for policymaking considering the high costs attributable to physical inactivity. However, the evidence for such interventions targeting type 2 diabetes control is scarce. Therefore, the present study aimed to synthesize economic evaluation studies of physical activity interventions for type 2 diabetes management. Methods A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement (PROSPERO reference number CRD42021231021). An electronic search was performed in PubMed, Web of Science, Cochrane Library and NHS Economic Evaluation Database. Studies were eligible if they included: adults with type 2 diabetes; any physical activity intervention in the community settings; an experimental or quasi-experimental design; and a parameter of economic evaluation [cost analysis of interventions, cost-effectiveness analysis (including cost-utility analysis) and cost-benefit analysis] as an outcome. Results Ten studies were included in this review: seven were randomized controlled trials and three were quasi-experimental studies. All studies included direct costs, and four also included indirect costs. Four studies demonstrated that physical activity interventions were cost-saving, six studies showed cost-effectiveness, and two studies reported cost-utility. The estimates varied considerably across the studies with different analytical and methodological approaches. Conclusion Overall, this systematic review found that physical activity interventions are a worth investment for type 2 diabetes management. However, comparability across interventions was limited due to heterogeneity in interventions type, design and delivery, which may explain the differences in the economic measures.
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Affiliation(s)
- Ana Barbosa
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Stephen Whiting
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Ding Ding
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - João Brito
- Portugal Football School, Portuguese Football Federation, Oeiras, Portugal
| | - Romeu Mendes
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,World Health Organization, Regional Office for Europe, Copenhagen, Denmark.,Portugal Football School, Portuguese Football Federation, Oeiras, Portugal.,ACES Douro I-Marão e Douro Norte, Northern Region Health Administration, Vila Real, Portugal
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Cunningham SG, Stoddart A, Wild SH, Conway NJ, Gray AM, Wake DJ. Cost-Utility of an Online Education Platform and Diabetes Personal Health Record: Analysis Over Ten Years. J Diabetes Sci Technol 2022; 17:715-726. [PMID: 34986658 DOI: 10.1177/19322968211069172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS My Diabetes My Way (MDMW) is Scotland's interactive website and mobile app for people with diabetes and their caregivers. It contains multimedia resources for diabetes education and offers access to electronic personal health records. This study aims to assess the cost-utility of MDMW compared with routine diabetes care in people with type 2 diabetes who do not use insulin. MATERIALS AND METHODS Analysis used the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model 2. Clinical parameters of MDMW users (n = 2576) were compared with a matched cohort of individuals receiving routine care alone (n = 11 628). Matching criteria: age, diabetes duration, sex, and socioeconomic status. Impact on life expectancy, quality-adjusted life years (QALYs), and costs of treatment and complications were simulated over ten years, including a 10% sensitivity analysis. RESULTS MDMW cohort: 1670 (64.8%) men; average age 64.3 years; duration of diabetes 5.5 years. 906 (35.2%) women: average age 61.6 years; duration 4.7 years. The cumulative mean QALY (95% CI) gain: 0.054 (0.044-0.062) years. Mean difference in cost: -£118.72 (-£150.16 to -£54.16) over ten years. Increasing MDMW costs (10%): -£50.49 (-£82.24-£14.14). Decreasing MDMW costs (10%): -£186.95 (-£218.53 to -£122.51). CONCLUSIONS MDMW is "dominant" over usual care (cost-saving and life improving) in supporting self-management in people with type 2 diabetes not treated with insulin. Wider use may result in significant cost savings through delay or reduction of long-term complications and improved QALYs in Scotland and other countries. MDMW may be among the most cost-effective interventions currently available to support diabetes.
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Affiliation(s)
| | - Andrew Stoddart
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Sarah H Wild
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Alastair M Gray
- Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford, UK
| | - Deborah J Wake
- Usher Institute, The University of Edinburgh, Edinburgh, UK
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Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review. PLoS One 2021; 16:e0260139. [PMID: 34793562 PMCID: PMC8601459 DOI: 10.1371/journal.pone.0260139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 11/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diabetes mellitus affects almost 10% of U.S. adults, leading to human and financial burden. Underserved populations experience a higher risk of diabetes and related complications resulting from a combination of limited disposable income, inadequate diet, and lack of insurance coverage. Without the requisite resources, underserved populations lack the ability to access healthcare and afford prescription drugs to manage their condition. The aim of this systematic review is to synthesize the findings from cost-effectiveness studies of diabetes management in underserved populations. METHODS Original, English, peer-reviewed cost-effectiveness studies of diabetes management in U.S. underserved populations were obtained from 8 databases, and PRISMA 2009 reporting guidelines were followed. Evidence was categorized as strong or weak based on a combination of GRADE and American Diabetes Association guidelines. Internal validity was assessed by the Cochrane methodology. Studies were classified by incremental cost-effectiveness ratio as very cost-effective (ICER≤US$25,000), cost-effective (US$25,000<ICER≤US$50,000), marginally cost-effective (US$50,000<ICER≤US$100,000) or cost-ineffective (ICER>US$100,000). Reporting and quality of economic evaluations was assessed using the CHEERS guidelines and Recommendations of Second Panel for Cost-Effectiveness in Health and Medicine, respectively. FINDINGS Fourteen studies were included. All interventions were found to be cost-effective or very cost-effective. None of the studies reported all 24 points of the CHEERS guidelines. Given the considered cost categories vary significantly between studies, assessing cost-effectiveness across studies has many limitations. Program costs were consistently analyzed, and a third of the included studies (n = 5) only examined these costs, without considering other costs of diabetes care. INTERPRETATION Cost-effectiveness studies are not based on a standardized methodology and present incomplete or limited analyses. More accurate assessment of all direct and indirect costs could widen the gap between intervention and usual care. This demonstrates the urgent need for a more standardized and comprehensive cost-effectiveness framework for future studies.
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Corrao G, Rea F, Mancia G, Perseghin G, Merlino L, Martini N, Carbone S, Carle F. Cost-effectiveness of the adherence with recommendations for clinical monitoring of patients with diabetes. Nutr Metab Cardiovasc Dis 2021; 31:3111-3121. [PMID: 34531108 DOI: 10.1016/j.numecd.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/31/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS To validate a set of indicators for monitoring the quality of care of patients with diabetes in 'real-life' practice through its relationship with measurable clinical outcomes and healthcare costs. METHODS AND RESULTS A population-based cohort study was carried out by including the 20,635 patients, residents in the Lombardy Region (Italy), who in the year 2012 were newly taken-in-care for diabetes. Adherence with clinical recommendations (i.e., controls for glycated haemoglobin, lipid profile, urine albumin excretion and serum creatinine) was recorded during the first year after the patient was taken-in-care, and categorized according whether he/she complied with none or almost none (0 or 1), just some (2) or all or almost all (3 or 4) the recommendations, respectively denoted as poor, intermediate and high adherence. Short- and long-term complications of diabetes, and healthcare cost incurred by the National Health Service, were assessed during follow-up. Compared with patients with poor adherence, those with intermediate and high adherence respectively showed (i) a delay in outcome occurrence of 13 days (95% CI, -2 to 27) and 23 days (9-38), and (ii) a lower healthcare cost of 54 € and 77 €. In average, a gain of 18 Euros and 15 Euros for each day free from diabetic complication by increasing adherence respectively from poor to intermediate and from poor to high were observed. CONCLUSION Close control of patients with diabetes through regular clinical examinations must be considered the cornerstone of national guidance, national audits, and quality improvement incentive schemes.
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Affiliation(s)
- Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | | | - Gianluca Perseghin
- Department of Internal Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; Department of Medicine and Surgery, Università Degli Studi di Milano-Bicocca, Italy
| | - Luca Merlino
- Epidemiologic Observatory, Lombardy Region Welfare Department, Milan, Italy
| | - Nello Martini
- Research and Health Foundation (Fondazione ReS -Ricerca e Salute-), Bologna, Italy
| | - Simona Carbone
- Department of Health Planning, Italian Health Ministry, Rome, Italy
| | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
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Inoue R, Nishiyama K, Li J, Miyashita D, Ono M, Terauchi Y, Shirakawa J. The Feasibility and Applicability of Stem Cell Therapy for the Cure of Type 1 Diabetes. Cells 2021; 10:cells10071589. [PMID: 34202521 PMCID: PMC8304653 DOI: 10.3390/cells10071589] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 12/25/2022] Open
Abstract
Stem cell therapy using islet-like insulin-producing cells derived from human pluripotent stem cells has the potential to allow patients with type 1 diabetes to withdraw from insulin therapy. However, several issues exist regarding the use of stem cell therapy to treat type 1 diabetes. In this review, we will focus on the following topics: (1) autoimmune responses during the autologous transplantation of stem cell-derived islet cells, (2) a comparison of stem cell therapy with insulin injection therapy, (3) the impact of the islet microenvironment on stem cell-derived islet cells, and (4) the cost-effectiveness of stem cell-derived islet cell transplantation. Based on these various viewpoints, we will discuss what is required to perform stem cell therapy for patients with type 1 diabetes.
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Affiliation(s)
- Ryota Inoue
- Laboratory of Diabetes and Metabolic Disorders, Institute for Molecular and Cellular Regulation (IMCR), Gunma University, Maebashi 371-8512, Japan; (R.I.); (K.N.); (J.L.)
| | - Kuniyuki Nishiyama
- Laboratory of Diabetes and Metabolic Disorders, Institute for Molecular and Cellular Regulation (IMCR), Gunma University, Maebashi 371-8512, Japan; (R.I.); (K.N.); (J.L.)
| | - Jinghe Li
- Laboratory of Diabetes and Metabolic Disorders, Institute for Molecular and Cellular Regulation (IMCR), Gunma University, Maebashi 371-8512, Japan; (R.I.); (K.N.); (J.L.)
| | - Daisuke Miyashita
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan; (D.M.); (M.O.); (Y.T.)
| | - Masato Ono
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan; (D.M.); (M.O.); (Y.T.)
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, Yokohama 236-0004, Japan; (D.M.); (M.O.); (Y.T.)
| | - Jun Shirakawa
- Laboratory of Diabetes and Metabolic Disorders, Institute for Molecular and Cellular Regulation (IMCR), Gunma University, Maebashi 371-8512, Japan; (R.I.); (K.N.); (J.L.)
- Correspondence: ; Tel.: +81-27-220-8850
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Bagepally BS, Chaikledkaew U, Gurav YK, Anothaisintawee T, Youngkong S, Chaiyakunapruk N, McEvoy M, Attia J, Thakkinstian A. Glucagon-like peptide 1 agonists for treatment of patients with type 2 diabetes who fail metformin monotherapy: systematic review and meta-analysis of economic evaluation studies. BMJ Open Diabetes Res Care 2020; 8:8/1/e001020. [PMID: 32690574 PMCID: PMC7371226 DOI: 10.1136/bmjdrc-2019-001020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/26/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To conduct a systematic review and meta-analysis and to pool the incremental net benefits (INBs) of glucagon-like peptide 1 (GLP1) compared with other therapies in type 2 diabetes mellitus (T2DM) after metformin monotherapy failure. RESEARCH DESIGN AND METHODS The study design is a systematic review and meta-analysis. We searched MEDLINE (via PubMed), Scopus and Tufts Registry for eligible cost-utility studies up to June 2018, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We conducted a systematic review and pooled the INBs of GLP1s compared with other therapies in T2DM after metformin monotherapy failure. Various monetary units were converted to purchasing power parity, adjusted to 2017 US$. The INBs were calculated and then pooled across studies, stratified by level of country income; a random-effects model was used if heterogeneity was present, and a fixed-effects model if it was absent. Heterogeneity was assessed using Q test and I2 statistic. RESULTS A total of 56 studies were eligible, mainly from high-income countries (HICs). The pooled INBs of GLP1s compared with dipeptidyl peptidase-4 inhibitor (DPP4i) (n=10), sulfonylureas (n=6), thiazolidinedione (TZD) (n=3), and insulin (n=23) from HICs were US$4012.21 (95% CI US$-571.43 to US$8595.84, I2=0%), US$3857.34 (95% CI US$-7293.93 to US$15 008.61, I2=45.9%), US$37 577.74 (95% CI US$-649.02 to US$75 804.50, I2=92.4%) and US$14 062.42 (95% CI US$8168.69 to US$19 956.15, I2=86.4%), respectively. GLP1s were statistically significantly cost-effective compared with insulins, but not compared with DPP4i, sulfonylureas, and TZDs. Among GLP1s, liraglutide was more cost-effective compared with lixisenatide, but not compared with exenatide, with corresponding pooled INBs of US$4555.09 (95% CI US$3992.60 to US$5117.59, I2=0) and US$728.46 (95% CI US$-1436.14 to US$2893.07, I2=0), respectively. CONCLUSION GLP1 agonists are a cost-effective choice compared with insulins, but not compared with DPP4i, sulfonylureas and TZDs. PROSPERO REGISTRATION NUMBER CRD42018105193.
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Affiliation(s)
- Bhavani Shankara Bagepally
- Non-Communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Yogesh Krishnarao Gurav
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Epidemiology Group, ICMR-National Institute of Virology, Pune, India
| | - Thunyarat Anothaisintawee
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sitaporn Youngkong
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | | | - Mark McEvoy
- Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, New Lambton, New South Wales, Australia
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, New Lambton, New South Wales, Australia
- Division of Medicine, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Abstract
OBJECTIVES Cost-effectiveness analyses are increasingly used to aid decisions about resource allocation in healthcare; this practice is slow to translate into critical care. We sought to identify and summarize original cost-effectiveness studies presenting cost per quality-adjusted life year, incremental cost-effectiveness ratios, or cost per life-year ratios for treatments used in ICUs. DESIGN We conducted a systematic search of the English-language literature for cost-effectiveness analyses published from 1993 to 2018 in critical care. Study quality was assessed using the Drummond checklist. SETTING Critical care units. PATIENTS OR SUBJECTS Critical care patients. INTERVENTIONS Identified studies with cost-effectiveness analyses. MEASUREMENTS AND MAIN RESULTS We identified 97 studies published through 2018 with 156 cost-effectiveness ratios. Reported incremental cost-effectiveness ratios ranged from -$119,635 (hypothetical cohort of patients requiring either intermittent or continuous renal replacement therapy) to $876,539 (data from an acute renal failure study in which continuous renal replacement therapy was the most expensive therapy). Many studies reported favorable cost-effectiveness profiles (i.e., below $50,000 per life year or quality-adjusted life year). However, several therapies have since been proven harmful. Over 2 decades, relatively few cost-effectiveness studies in critical care have been published (average 4.6 studies per year). There has been a more recent trend toward using hypothetical cohorts and modeling scenarios without proven clinical data (2014-2018: 19/33 [58%]). CONCLUSIONS Despite critical care being a significant healthcare cost burden there remains a paucity of studies in the literature evaluating its cost effectiveness.
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Bagepally BS, Gurav YK, Anothaisintawee T, Youngkong S, Chaikledkaew U, Thakkinstian A. Cost Utility of Sodium-Glucose Cotransporter 2 Inhibitors in the Treatment of Metformin Monotherapy Failed Type 2 Diabetes Patients: A Systematic Review and Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1458-1469. [PMID: 31806203 DOI: 10.1016/j.jval.2019.09.2750] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/05/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) and associated ailments are leading economic burdens to society. Sodium glucose cotransporter-2 (SGLT2) inhibitors are recent antidiabetic medications with beneficial clinical efficacy. This meta-analysis was conducted to quantitatively pool the incremental net benefit of SGLT2 inhibitors in T2DM patients who failed metformin monotherapy. METHODS Relevant economic evaluation studies of T2DM patients were identified from PubMed, Scopus, ProQuest, the Cochrane Library, and the Tufts Cost-Effective Analysis Registry until June 2018. Studies were eligible if they studied T2DM patients who failed metformin monotherapy and assessed the cost-effectiveness/utility between SGLT2 inhibitors and other treatments. Details of the study characteristics, economic model inputs, costs, and outcomes were extracted. Risk of bias was assessed using the biases in economic studies (ECOBIAS) checklist. The incremental net benefit was calculated with monetary units adjusting for purchasing power parity for 2017 US dollars. This was then pooled across studies stratified by the country's level of income using a random-effect model if heterogeneity was present and with a fixed-effect model otherwise. Heterogeneity was assessed using the Q test and I2 statistic. RESULTS A total of 13 studies with 22 comparisons, mainly from high-income countries, were eligible. Six and 4 studies compared SGLT2 with dipeptidyl peptidase-4 inhibitors (DPP4i) and sulfonylureas, respectively. The pooled incremental net benefits (95% confidence interval) for these corresponding comparisons were $164.95 (-$534.71 to $864.61; I2 = 0%) and $3675.09 ($1656.46-$5693.71; I2 = 85.4%), respectively. These results indicate that SGLT2s were cost-effective in comparison with sulfonylureas but not DPP4i. CONCLUSION SGLT2s were cost-effective as compared with sulfonylureas but not DPP4i. Most of the evidence was from high-income countries with few comparative drug groups, and the results might not be representative of the actual global scenario. Further studies from middle and lower economies and other comparators are still required.
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Affiliation(s)
- Bhavani Shankara Bagepally
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand; ICMR-National Institute of Epidemiology, Chennai, India
| | - Yogesh Krishnarao Gurav
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand; ICMR-National Institute of Virology, Pune, India
| | - Thunyarat Anothaisintawee
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand; Department of Family Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sitaporn Youngkong
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand; Department of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand; Department of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand; Section for Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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11
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Pettus JH, Zhou FL, Shepherd L, Preblick R, Hunt PR, Paranjape S, Miller KM, Edelman SV. Incidences of Severe Hypoglycemia and Diabetic Ketoacidosis and Prevalence of Microvascular Complications Stratified by Age and Glycemic Control in U.S. Adult Patients With Type 1 Diabetes: A Real-World Study. Diabetes Care 2019; 42:2220-2227. [PMID: 31548241 DOI: 10.2337/dc19-0830] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/27/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the burden of disease for adults with type 1 diabetes in a U.S. electronic health record database by evaluating acute and microvascular complications stratified by age and glycemic control. RESEARCH DESIGN AND METHODS This is a retrospective observational study of adults with type 1 diabetes (1 July 2014-30 June 2016) classified using a validated algorithm, with disease duration ≥24 months and, during a 12-month baseline period, not pregnant and having one or more insulin prescriptions and one or more HbA1c measurements. Demographic characteristics, acute complications (severe hypoglycemia [SH], diabetic ketoacidosis [DKA]), and microvascular complications (neuropathy, nephropathy, retinopathy) were stratified by age (18-25, 26-49, 50-64, ≥65 years) and glycemic control (HbA1c <7%, 7% to <9%, ≥9%). RESULTS Of 31,430 patients, ∼20% had HbA1c <7%. Older patients had lower HbA1c values than younger patients (P < 0.001). Patients with poor glycemic control had the highest annual incidence of SH (4.2%, 4.0%, and 8.3%) and DKA (1.3%, 2.8%, and 15.8%) for HbA1c <7%, 7% to <9%, and ≥9% cohorts, respectively (both P < 0.001), and a higher prevalence of neuropathy and nephropathy (both P < 0.001). CONCLUSIONS For adults with type 1 diabetes, glycemic control appears worse than previously estimated. Rates of all complications increased with increasing HbA1c. Compared with HbA1c <7%, HbA1c ≥9% was associated with twofold and 12-fold higher incidences of SH and DKA, respectively. Younger adults had more pronounced higher risks of SH and DKA associated with poor glycemic control than older adults.
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Affiliation(s)
| | | | | | | | | | | | | | - Steven V Edelman
- Veterans Affairs Medical Center, University of California San Diego, San Diego, CA
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12
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Thewjitcharoen Y, Yenseung N, Malidaeng A, Butadej S, Chotwanvirat P, Krittiyawong S, Thammawiwat C, Himathongkam T. Effectiveness of Insulin Degludec in Thai Patients with Diabetes Mellitus: Real-World Evidence From a Specialized Diabetes Center. Exp Clin Endocrinol Diabetes 2019; 129:666-673. [PMID: 31597169 PMCID: PMC8416321 DOI: 10.1055/a-0899-5118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background
Insulin degludec, an ultra-long-acting insulin analogue, has been available in Thailand since October 2016. Although clinical trial results revealed less hypoglycemia, data from real-world settings is limited especially in Asian patients. This study aimed to evaluate prospectively the real-world effectiveness, safety, quality of life (QOL) and patient satisfaction with insulin degludec among Thai patients with diabetes mellitus (DM).
Methods
From October 2016 to September 2017, all patients who had started insulin degludec for at least 3 months were observed and evaluated at baseline, 3, 6, and 12 months. QOL was assessed using WHOQOL-BREF-THAI and level of satisfaction was measured by 7-point Likert scale. Glycemic fluctuation from paired iPro2 continuous glucose monitoring (CGM) obtained 4–6 weeks apart were also evaluated from a subset of patients with T1DM who switched from insulin glargine to insulin degludec.
Results
A total of 55 patients (T2DM 76.4%, females 54.5%, mean age 57.1±16.1 years, duration of diabetes 16.7±8.8 years, BMI 27.3±5.5 kg/m
2
, baseline A1C 9.3±2.3%, median duration of treatment 8 months) were included in the study. In T1DM patients (n=13), the overall mean A1C reduction at 12 months was 0.5% with minimal weight gain of 0.9 kgs at 12 months. In T2DM patients (n=42), the overall mean A1C reduction at 12 months was 0.8% with minimal weight loss of 0.4 kgs at 12 months. The proportion of T1DM patients who could achieve optimal glycemic control increased slightly from 14.3 to 18.2% but the proportion of T2DM patients who could achieve optimal glycemic control increased from 30.8 to 53.8%. Patient satisfaction showed a sustained improvement throughout the duration of study. In four T1DM patients who had paired CGM data, insulin degludec provided greater reductions in glycemic variability endpoints with increased time-in-range when compared with previous insulin glargine.
Discussion
Our data suggested that the effectiveness of insulin degludec was consistent with the results seen in clinical trials with lower risk of patients-reported hypoglycemia, and a significant improvement in glycemic control. Patients also reported higher treatment satisfaction. More long-term and cost-effectiveness data are needed to establish the role of this ultra-long-acting insulin in real-world settings.
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Affiliation(s)
| | - Nalin Yenseung
- Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
| | - Areeya Malidaeng
- Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
| | - Siriwan Butadej
- Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
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13
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Adua E, Memarian E, Russell A, Trbojević-Akmačić I, Gudelj I, Jurić J, Roberts P, Lauc G, Wang W. Utilization of N-glycosylation profiles as risk stratification biomarkers for suboptimal health status and metabolic syndrome in a Ghanaian population. Biomark Med 2019; 13:1273-1287. [DOI: 10.2217/bmm-2019-0005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: The study sought to apply N-glycosylation profiles to understand the interplay between suboptimal health status (SHS) and metabolic syndrome (MetS). Materials & methods: In this study, 262 Ghanaians were recruited from May to July 2016. After completing a health survey, plasma samples were collected for clinical assessments while ultra performance liquid chromatography was used to measure plasma N-glycans. Results: Four glycan peaks were found to predict case status (MetS and SHS) using a step-wise Akaike’s information criterion logistic regression model selection. This model yielded an area under the curve of MetS: 83.1% (95% CI: 78.0–88.1%) and SHS: 67.1% (60.6–73.7%). Conclusion: Our results show that SHS is a significant, albeit modest, risk factor for MetS and N-glycan complexity was associated with MetS.
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Affiliation(s)
- Eric Adua
- School of Medical & Health Sciences, Edith Cowan University, WA 6027, Australia
| | - Elham Memarian
- Genos Glycoscience Research Laboratory, Zagreb 10000, Croatia
| | - Alyce Russell
- School of Medical & Health Sciences, Edith Cowan University, WA 6027, Australia
| | | | - Ivan Gudelj
- Genos Glycoscience Research Laboratory, Zagreb 10000, Croatia
| | - Julija Jurić
- Genos Glycoscience Research Laboratory, Zagreb 10000, Croatia
| | - Peter Roberts
- School of Medical & Health Sciences, Edith Cowan University, WA 6027, Australia
| | - Gordan Lauc
- Genos Glycoscience Research Laboratory, Zagreb 10000, Croatia
- University of Zagreb, Faculty of Pharmacy & Biochemistry, Zagreb 10000, Croatia
| | - Wei Wang
- School of Medical & Health Sciences, Edith Cowan University, WA 6027, Australia
- School of Public Health, Taishan Medical University, Shandong, Taian 271000, PR China
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing 100069, PR China
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14
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Bandeiras C, Cabral JMS, Gabbay RA, Finkelstein SN, Ferreira FC. Bringing Stem Cell‐Based Therapies for Type 1 Diabetes to the Clinic: Early Insights from Bioprocess Economics and Cost‐Effectiveness Analysis. Biotechnol J 2019; 14:e1800563. [DOI: 10.1002/biot.201800563] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/21/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Cátia Bandeiras
- Department of Bioengineering, iBB—Institute for Bioengineering and Biosciences, Instituto Superior TécnicoUniversidade de Lisboa 1049‐001 Lisboa Portugal
- The Discoveries Center for Regenerative and Precision Medicine, Lisbon CampusInstituto Superior Técnico, Universidade de Lisboa 1049‐001 Lisboa Portugal
- Division of Clinical Informatics, Department of MedicineBeth Israel Deaconess Medical Center 1330 Beacon Street Brookline MA 02446 USA
| | - Joaquim M. S. Cabral
- Department of Bioengineering, iBB—Institute for Bioengineering and Biosciences, Instituto Superior TécnicoUniversidade de Lisboa 1049‐001 Lisboa Portugal
- The Discoveries Center for Regenerative and Precision Medicine, Lisbon CampusInstituto Superior Técnico, Universidade de Lisboa 1049‐001 Lisboa Portugal
| | - Robert A. Gabbay
- Joslin Diabetes Medical CenterHarvard Medical School One Joslin Place Boston MA 02216 USA
| | - Stan N. Finkelstein
- Division of Clinical Informatics, Department of MedicineBeth Israel Deaconess Medical Center 1330 Beacon Street Brookline MA 02446 USA
- Institute for Data, Systems and SocietyMassachusetts Institute of Technology 50 Ames Street Cambridge MA 02139 USA
| | - Frederico Castelo Ferreira
- Department of Bioengineering, iBB—Institute for Bioengineering and Biosciences, Instituto Superior TécnicoUniversidade de Lisboa 1049‐001 Lisboa Portugal
- The Discoveries Center for Regenerative and Precision Medicine, Lisbon CampusInstituto Superior Técnico, Universidade de Lisboa 1049‐001 Lisboa Portugal
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15
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Xie F, Zoratti M, Chan K, Husereau D, Krahn M, Levine O, Clifford T, Schunemann H, Guyatt G. Toward a Centralized, Systematic Approach to the Identification, Appraisal, and Use of Health State Utility Values for Reimbursement Decision Making: Introducing the Health Utility Book (HUB). Med Decis Making 2019; 39:370-378. [PMID: 30902030 DOI: 10.1177/0272989x19837969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cost-utility analysis (CUA) is a widely recommended form of health economic evaluation worldwide. The outcome measure in CUA is quality-adjusted life-years (QALYs), which are calculated using health state utility values (HSUVs) and corresponding life-years. Therefore, HSUVs play a significant role in determining cost-effectiveness. Formal adoption and endorsement of CUAs by reimbursement authorities motivates methodological advancement in HSUV measurement and application. A large body of evidence exploring various methods in measuring HSUVs has accumulated, imposing challenges for investigators in identifying and applying HSUVs to CUAs. First, large variations in HSUVs between studies are often reported, and these may lead to different cost-effectiveness conclusions. Second, issues concerning the quality of studies that generate HSUVs are increasingly highlighted in the literature. This issue is compounded by the limited published guidance and methodological standards for assessing the quality of these studies. Third, reimbursement decision making is a context-specific process. Therefore, while an HSUV study may be of high quality, it is not necessarily appropriate for use in all reimbursement jurisdictions. To address these issues, by promoting a systematic approach to study identification, critical appraisal, and appropriate use, we are developing the Health Utility Book (HUB). The HUB consists of an HSUV registry, a quality assessment tool for health utility studies, and a checklist for interpreting their use in CUAs. We anticipate that the HUB will make a timely and important contribution to the rigorous conduct and proper use of health utility studies for reimbursement decision making. In this way, health care resource allocation informed by HSUVs may reflect the preferences of the public, improve health outcomes of patients, and maintain the efficiency of health care systems.
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Affiliation(s)
- Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Program for Health Economics and Outcome Measures (PHENOM), Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Michael Zoratti
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada
| | - Kelvin Chan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Don Husereau
- Institute of Health Economics, Edmonton, Alberta, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Murray Krahn
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Oren Levine
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Tammy Clifford
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Holger Schunemann
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada
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16
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Affiliation(s)
- Anushka Patel
- From The George Institute for Global Health, University of New South Wales, Sydney, Australia.
| | - Laurent Billot
- From The George Institute for Global Health, University of New South Wales, Sydney, Australia
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17
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Adua E, Memarian E, Russell A, Trbojević-Akmačić I, Gudelj I, Jurić J, Roberts P, Lauc G, Wang W. High throughput profiling of whole plasma N-glycans in type II diabetes mellitus patients and healthy individuals: A perspective from a Ghanaian population. Arch Biochem Biophys 2019; 661:10-21. [DOI: 10.1016/j.abb.2018.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 12/25/2022]
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18
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Sortsø C, Komkova A, Sandbæk A, Griffin SJ, Emneus M, Lauritzen T, Simmons RK. Effect of screening for type 2 diabetes on healthcare costs: a register-based study among 139,075 individuals diagnosed with diabetes in Denmark between 2001 and 2009. Diabetologia 2018; 61:1306-1314. [PMID: 29549417 DOI: 10.1007/s00125-018-4594-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS Trials have not demonstrated benefits to the population of screening for type 2 diabetes. However, there may be cost savings for those found to have diabetes. We therefore aimed to compare healthcare costs among individuals with incident type 2 diabetes in a screened group with those in an unscreened group. METHODS In this register-based, non-randomised controlled trial, eligible individuals were men and women aged 40-69 years without known diabetes who were registered with a general practice in Denmark (n = 1,912,392). Between 2001 and 2006, 153,107 individuals registered with 181 practices participating in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care (ADDITION)-Denmark study were sent a diabetes risk-score questionnaire. Individuals with a moderate-to-high risk were invited to visit their family doctor for assessment of diabetes status and cardiovascular risk (screening group). The 1,759,285 individuals registered with all other practices in Denmark constituted the retrospectively constructed no-screening (control) group. In this post hoc analysis, we identified individuals from the screening and no-screening groups who were diagnosed with diabetes between 2001 and 2009 (n = 139,075). Using national registry data, we quantified the cost of healthcare services in these two groups between 2001 and 2012. From a healthcare sector perspective, we estimated the potential healthcare cost savings for individuals with diabetes that were attributable to the screening programme. RESULTS In the screening group, 27,177 of 153,107 individuals (18% of those sent a risk-score questionnaire) attended for screening, 1533 of whom were diagnosed with diabetes. Between 2001 and 2009, 13,992 people were newly diagnosed with diabetes in the screening group (including those diagnosed by screening) and 125,083 in the no-screening group. Healthcare costs were significantly lower in the screening group compared with the no-screening group (difference in mean total annual healthcare costs -€889 per individual with incident diabetes; 95% CI -€1196, -€581). The screening programme was associated with a cost saving per person with incident diabetes over a 5-year period of €2688 (95% CI €1421, €3995). CONCLUSIONS/INTERPRETATION Healthcare costs were lower among individuals with incident type 2 diabetes in the screened group compared with the unscreened group. The relatively modest cost of screening per person discovered to have developed diabetes was offset within 2 years by savings in the healthcare system.
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Affiliation(s)
- Camilla Sortsø
- Applied Economics and Health Research Aps, Ewaldsgade 3, 2200, Copenhagen N, Denmark.
| | - Anastasija Komkova
- Applied Economics and Health Research Aps, Ewaldsgade 3, 2200, Copenhagen N, Denmark
| | - Annelli Sandbæk
- Department of Public Health, Section of General Practice, Aarhus, Denmark
| | - Simon J Griffin
- Department of Public Health, Section of General Practice, Aarhus, Denmark
- Primary Care Unit, Institute of Public Health, Cambridge, UK
| | - Martha Emneus
- Applied Economics and Health Research Aps, Ewaldsgade 3, 2200, Copenhagen N, Denmark
| | - Torsten Lauritzen
- Department of Public Health, Section of General Practice, Aarhus, Denmark
| | - Rebecca K Simmons
- Department of Public Health, Section of General Practice, Aarhus, Denmark.
- Danish Diabetes Academy, Odense University Hospital, Odense, Denmark.
- Aarhus Institute of Advanced Studies, Aarhus, Denmark.
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0AH, UK.
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19
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Mechanick JI, Leroith D. Synthesis: Deriving a Core Set of Recommendations to Optimize Diabetes Care on a Global Scale. Ann Glob Health 2018; 81:874-83. [PMID: 27108155 DOI: 10.1016/j.aogh.2016.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diabetes afflicts 382 million people worldwide, with increasing prevalence rates and adverse effects on health, well-being, and society in general. There are many drivers for the complex presentation of diabetes, including environmental and genetic/epigenetic factors. OBJECTIVE The aim was to synthesize a core set of recommendations from information from 14 countries that can be used to optimize diabetes care on a global scale. METHODS Information from 14 papers in this special issue of Annals of Global Health was reviewed, analyzed, and sorted to synthesize recommendations. PubMed was searched for relevant studies on diabetes and global health. FINDINGS Key findings are as follows: (1) Population-based transitions distinguish region-specific diabetes care; (2) biological drivers for diabetes differ among various populations and need to be clarified scientifically; (3) principal resource availability determines quality-of-care metrics; and (4) governmental involvement, independent of economic barriers, improves the contextualization of diabetes care. Core recommendations are as follows: (1) Each nation should assess region-specific epidemiology, the scientific evidence base, and population-based transitions to establish risk-stratified guidelines for diagnosis and therapeutic interventions; (2) each nation should establish a public health imperative to provide tools and funding to successfully implement these guidelines; and (3) each nation should commit to education and research to optimize recommendations for a durable effect. CONCLUSIONS Systematic acquisition of information about diabetes care can be analyzed, extrapolated, and then used to provide a core set of actionable recommendations that may be further studied and implemented to improve diabetes care on a global scale.
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Affiliation(s)
- Jeffrey I Mechanick
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Derek Leroith
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY
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20
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Linagliptin versus sitagliptin in patients with type 2 diabetes mellitus: a network meta-analysis of randomized clinical trials. ACTA ACUST UNITED AC 2017; 25:23. [PMID: 29070077 PMCID: PMC5655990 DOI: 10.1186/s40199-017-0189-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/02/2017] [Indexed: 01/19/2023]
Abstract
Background Diabetes is one of the most common chronic and costly diseases worldwide and type 2 diabetes is the most common type which accounts for about 90% of cases with diabetes. New medication-therapy regimens such as those containing linagliptin alone or in combination with other medications (within the category of DDP-4 inhibitors) must be evaluated in terms of efficacy and compared with other currently used drugs and then enter the medication list of the country. Hence, this study aimed to compare the clinical efficacy of the two drugs, i.e. linagliptin and sitagliptin, in patients with type 2 diabetes. Methods A systematic review was conducted to identify all clinical trials published by 2015 which compared the two drugs in patients with type 2 diabetes. Using keywords such as “linagliptin”, “type 2 diabetes mellitus”, “sitagliptin” and related combinations, we searched databases including Scopus, PubMed, and Web of Science. The quality of the selected studies was evaluated using the Jadad score. Considering primary and secondary outcomes extracted from the reviewed studies, a network meta-analysis was used to conduct a systematic comparison between the two studied drugs. Results This network meta-analysis included 32 studies (Linagliptin vs PLB: n = 8, Sitagliptin vs PLB: n = 13, Linagliptin + MET vs PLB + MET: n = 4, and Sitagliptin + MET vs PLB + MET: n = 7) and a total of 13,747 patients. The results showed no significant difference between linagliptin and sitagliptin in terms of key efficacy and safety outcomes such as HbA1c changes from baseline, body weight change from baseline, percentage of patients achieving HbA1c <7, and percentage of patients experiencing hypoglycemic events (p > 0.05). The results showed that the efficacy of the two drug regimens was the same. Conclusions Based on the results, there was no significant difference between the two drugs, i.e. linagliptin and sitagliptin, in terms of efficacy; in other words, the efficacy of the two drugs was the same. Therefore, the use of these two drugs depends on their availability and cost. Graphical abstract Graphical abstract of the network meta-analysis performed to evaluate the alternatives under the study.![]() Electronic supplementary material The online version of this article (10.1186/s40199-017-0189-6) contains supplementary material, which is available to authorized users.
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21
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Hettiarachchi RM, Kularatna S, Downes MJ, Byrnes J, Kroon J, Lalloo R, Johnson NW, Scuffham PA. The cost-effectiveness of oral health interventions: A systematic review of cost-utility analyses. Community Dent Oral Epidemiol 2017; 46:118-124. [DOI: 10.1111/cdoe.12336] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 08/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ruvini M. Hettiarachchi
- Centre for Applied Health Economics; School of Medicine; Griffith University; Nathan QLD Australia
- Menzies Health Institute Queensland; Griffith University; QLD Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation; Queensland University of Technology; Kelvin Grove QLD Australia
| | - Martin J. Downes
- Centre for Applied Health Economics; School of Medicine; Griffith University; Nathan QLD Australia
- Menzies Health Institute Queensland; Griffith University; QLD Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics; School of Medicine; Griffith University; Nathan QLD Australia
- Menzies Health Institute Queensland; Griffith University; QLD Australia
| | - Jeroen Kroon
- Menzies Health Institute Queensland; Griffith University; QLD Australia
- School of Dentistry and Oral Health; Griffith University; Gold Coast QLD Australia
| | - Ratilal Lalloo
- School of Dentistry; University of Queensland; Herston QLD Australia
| | - Newell W. Johnson
- Menzies Health Institute Queensland; Griffith University; QLD Australia
- School of Dentistry and Oral Health; Griffith University; Gold Coast QLD Australia
| | - Paul A. Scuffham
- Centre for Applied Health Economics; School of Medicine; Griffith University; Nathan QLD Australia
- Menzies Health Institute Queensland; Griffith University; QLD Australia
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22
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Al-Shahwan MA, Al-Othman AM, Al-Daghri NM, Sabico SB. Effects of 12-month, 2000IU/day vitamin D supplementation on treatment naïve and vitamin D deficient Saudi type 2 diabetic patients. Saudi Med J 2016; 36:1432-8. [PMID: 26620985 PMCID: PMC4707399 DOI: 10.15537/smj.2015.12.12923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: To determine whether 12-month, 2000IU/day vitamin D supplementation cardiometabolically improves treatment naïve type 2 diabetes mellitus (T2DM) Saudi patients with vitamin D deficiency. Methods: This 12-month interventional study was conducted at primary health centers in 5 different residential areas in Riyadh, Saudi Arabia between January 2013 and January 2014. Forty-five Saudi T2DM patients were enrolled. Baseline anthropometrics, glycemic, and lipid profiles were measured and repeated after 6 and 12 months. All subjects were provided with 2000IU vitamin D supplements for one year. Results: Vitamin D deficiency at baseline was 46.7%, 31.8% after 6 months, and 35.6% after 12 months, indicating an overall improvement in the vitamin D status in the entire cohort. Insulin and homeostatic model assessment-insulin resistance (HOMA-IR) after 12 months were significantly lower than a 6 months (p<0.05), but comparable to baseline values. Mean levels of triglycerides increased overtime from baseline (1.9±0.01 mmol/l) to 12 months (2.1±0.2 mmol). This modest increase in serum triglycerides was parallel to the insignificant decrease in circulating high-density lipoprotein -cholesterol levels. Conclusion: Twelve-month vitamin D supplementation of 2000IU per day in a cohort of treatment naïve Saudi patients with T2DM resulted in improvement of several cardiometabolic parameters including systolic blood pressure, insulin, and HOMA-IR. Further studies that include a placebo group are suggested to reinforce findings.
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Affiliation(s)
- May A Al-Shahwan
- Department of Community Health Sciences, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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23
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Zafon C. [New therapeutic approaches in type 2 diabetes mellitus]. Med Clin (Barc) 2015; 145:485-7. [PMID: 26142571 DOI: 10.1016/j.medcli.2015.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 05/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Carles Zafon
- Unidad de Investigación en Diabetes y Metabolismo, Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Instituto de Investigación Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Barcelona, España.
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