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Alluhidan M, Alturaiki A, Alabdulkarim H, Aljehani N, Alghamdi EA, Alsabaan F, Alamri AA, Malkin SJP, Hunt B, Alhossan A, Al-Jedai A. Modeling the Clinical and Economic Burden of Therapeutic Inertia in People with Type 2 Diabetes in Saudi Arabia. Adv Ther 2024:10.1007/s12325-024-02978-8. [PMID: 39261418 DOI: 10.1007/s12325-024-02978-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 08/20/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION Therapeutic inertia in type 2 diabetes, defined as a failure to intensify treatment despite poor glycemic control, can arise due to a variety of factors, despite evidence linking improved glycemic control with reductions in diabetes-related complications. The present study aimed to evaluate the health and economic burden of therapeutic inertia in people with type 2 diabetes in Saudi Arabia. METHODS The IQVIA Core Diabetes Model (v.9.0) was used to evaluate outcomes. Baseline cohort characteristics were sourced from Saudi-specific data, with baseline glycated hemoglobin (HbA1c) tested at 8.0%, 9.0%, and 10.0%. Modeled subjects were brought to an HbA1c target of 7.0% immediately or after delays of 1-5 years across time horizons of 3-50 years. Outcomes were discounted annually at 3.0%. Costs were accounted from a societal perspective and expressed in 2023 Saudi Arabian Riyals (SAR). RESULTS Immediate glycemic control was associated with improved or equal life expectancy and quality-adjusted life expectancy and cost savings in all scenarios compared with delays in achieving target HbA1c. Combined cost savings ranged from SAR 411 (EUR 102) per person with a baseline HbA1c of 8.0% versus a 1-year delay over a 3-year time horizon, to SAR 21,422 (EUR 5291) per person with a baseline HbA1c of 10.0% versus a 5-year delay over a 50-year time horizon. Discounted life expectancy and quality-adjusted life expectancy were projected to improve by up to 0.4 years and 0.5 quality-adjusted life years (QALYs), respectively, with immediate glycemic control. CONCLUSION Therapeutic inertia was associated with a substantial health and economic burden in Saudi Arabia. Interventions and initiatives that can help to reduce therapeutic inertia are likely to improve health outcomes and reduce healthcare expenditure.
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Affiliation(s)
| | - Abdulrahman Alturaiki
- Pharmaceutical Care Department, King Abdul Aziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hana Alabdulkarim
- Drug Policy and Economic Centre, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Doctoral School of Applied Informatics and Applied Mathematics, Obuda University, Budapest, Hungary
| | | | | | - Fahad Alsabaan
- Division of Endocrinology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdullah A Alamri
- Endocrinology Department, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | | | - Barnaby Hunt
- Ossian Health Economics and Communications, Basel, Switzerland
| | | | - Ahmed Al-Jedai
- College of Pharmacy, Alfaisal University, Riyadh, Saudi Arabia
- Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
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Catrina SB, Amadid H, Braae UC, Dereke J, Ekberg NR, Klanger B, Jansson S. PIONEER REAL Sweden: A Multicentre, Prospective, Real-World Observational Study of Oral Semaglutide Use in Adults with Type 2 Diabetes in Swedish Clinical Practice. Diabetes Ther 2024; 15:2079-2095. [PMID: 39052163 PMCID: PMC11330427 DOI: 10.1007/s13300-024-01614-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/19/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION The study was designed to assess outcomes with once-daily oral semaglutide in adults with type 2 diabetes (T2D) naïve to injectable glucose-lowering agents, in Swedish clinical practice. METHODS In this non-interventional, multicentre study, participants initiated oral semaglutide and were followed for 34-44 weeks. The primary endpoint was glycated haemoglobin (HbA1c) change from baseline to end of study (EOS). Secondary endpoints included body weight (BW) change from baseline to EOS, proportion of participants achieving HbA1c < 7%, and proportion achieving both a HbA1c reduction ≥ 1% and BW reduction of ≥ 3% or ≥ 5%, at EOS. Participants completed Diabetes Treatment Satisfaction Questionnaires (DTSQ status/change) and a dosing conditions questionnaire. RESULTS A total of 187 participants (mean age 62.5 years) initiated oral semaglutide. Baseline mean HbA1c and BW were 7.8% (n = 177) and 96.9 kg (n = 165), respectively. Estimated mean changes in HbA1c and BW were - 0.88%-points (95% confidence interval [CI] - 1.01 to - 0.75; P < 0.0001) and - 4.72% (95% CI - 5.58 to - 3.86; P < 0.0001), respectively. At EOS, 64.6% of participants had HbA1c < 7%, and 22.9% achieved HbA1c reduction of ≥ 1% and BW reduction of ≥ 5%. DTSQ status and change scores improved by 1.44 (P = 0.0260) and 12.3 points (P < 0.0001), respectively. Oral semaglutide was easy or very easy to consume for 86.4% of participants. Most common adverse events (AEs) were gastrointestinal disorders; nine participants (4.8%) had serious AEs; one (0.5%) experienced severe hypoglycaemia. CONCLUSION In this real-world study population, we observed significant reductions in HbA1c and BW in people living with T2D when prescribed semaglutide tablets as part of routine clinical practice in Sweden, with improved treatment satisfaction among participants and no new safety concerns. TRIAL REGISTRATION NCT04601753.
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Affiliation(s)
- Sergiu-Bogdan Catrina
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
- Centrum for Diabetes, Academic Specialist Centrum, Stockholm, Sweden.
- , K1 Molekylär Medicin Och Kirurgi, K1 MMK Tillväxt & Metabolism, 171 76, Stockholm, Sweden.
| | | | | | | | - Neda Rajamand Ekberg
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Centrum for Diabetes, Academic Specialist Centrum, Stockholm, Sweden
| | - Boris Klanger
- LäkarGruppen, Källgatan 10, 722 11, Västerås, Sweden
| | - Stefan Jansson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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AlHarbi M, Othman A, Nahari AA, Al-Jedai AH, Cuadras D, Almalky F, AlAzmi F, Almudaiheem HY, AlShubrumi H, AlSwat H, AlSahafi H, Sindi K, Basaikh K, AlQahtani M, Lamotte M, Yahia M, Hassan MEK, AlMutlaq M, AlRoaly M, AlZelaye S, AlGhamdi Z. Burden of Illness of Type 2 Diabetes Mellitus in the Kingdom of Saudi Arabia: A Five-Year Longitudinal Study. Adv Ther 2024; 41:1120-1150. [PMID: 38240948 PMCID: PMC10879361 DOI: 10.1007/s12325-023-02772-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/13/2023] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is associated with huge clinical and economic burden in the Kingdom of Saudi Arabia (KSA) which can be curtailed by efficacious treatment. In order to achieve this, current treatment pathways for T2DM and associated costs need to be assessed. METHODS A longitudinal cohort review was conducted to collect country-specific and patient-specific clinical data, over a minimum observation period of 5 years in the KSA. Patient demographics, clinical characteristics and treatment patterns were recorded. The IQVIA Core Diabetes Model (CDM) version 9.5 Plus was used to assess the burden of illness, which included long-term projections of clinical (life expectancy [LE], quality-adjusted life-years [QALYs], event rates of diabetes-related complications) and direct medical cost (per-patient annual or lifelong [50 years]) outcomes of the most commonly used first-line (1st-line) regimens for T2DM from a payer perspective in the KSA. RESULTS Data were collected from a subpopulation of 638 patients from 15 participating centres. There was an equal gender representation with a majority of the patients belonging to Arabian/Saudi ethnicity (71.0%). Biguanides (81.5%), sulfonylureas (51.6%), dipeptidyl peptidase 4 (DPP4) inhibitors (26.2%) and fast-acting insulins (17.2%) were the most prescribed 1st-line agents. The most frequently used 1st-line regimens resulted in an estimated LE of 25-28 years, QALYs of 18-21 years and lifelong total cost of illness of 201,377-437,371 Saudi Arabian riyal (53,700-116,632 US dollars). CONCLUSION Our study addresses gaps in the current research by providing a complete landscape of baseline demographic, clinical characteristics and treatment patterns from a heterogeneous group of patients with T2DM in the KSA. Additionally, the burden of illness analysis using CDM showed substantially higher cost of T2DM care from a payer perspective in the KSA.
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Affiliation(s)
| | - Abdullah Othman
- Aseer Central Hospital, Aseer Diabetes Centre, Abha, Saudi Arabia
| | | | | | | | - Faisal Almalky
- Diabetology Center, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Fayez AlAzmi
- Endocrine and Diabetes Specialized Center, Al-Qurayyat General Hospital, Qurayyat, Saudi Arabia
| | | | - Hamad AlShubrumi
- Buraidah Diabetes Centre, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Hameed AlSwat
- King Abdulaziz Specialized Hospital, Taif, Saudi Arabia
| | - Homaid AlSahafi
- Diabetes and Endocrinology Center, Hera General Hospital, Makkah, Saudi Arabia
| | | | - Khadija Basaikh
- Endocrine and Diabetes Center, King Abdulaziz Hospital, Jeddah, Saudi Arabia
| | - Majed AlQahtani
- Diabetes Center, King Fahad Specialized Hospital, Tabuk, Saudi Arabia
| | | | | | | | | | - Mohammed AlRoaly
- Endocrine and Diabetic Center, King Abdulaziz Specialist Hospital, Jouf, Saudi Arabia
| | - Somaya AlZelaye
- Center of Endocrinology and Diabetes Mellitus, Al-Qunfudah General Hospital, Al-Qunfudah, Makkah Province, Saudi Arabia
| | - Zein AlGhamdi
- Diabetes Centre at King Fahad Hospital, Madina, Saudi Arabia
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Pérez A, Redondo-Antón J, Romera I, Lizán L, Rubio-de Santos M, Díaz-Cerezo S, Orozco-Beltrán D. Disease and Economic Burden of Poor Metabolic and Weight Control in Type 2 Diabetes in Spain: A Systematic Literature Review. Diabetes Ther 2024; 15:325-341. [PMID: 37989829 PMCID: PMC10838877 DOI: 10.1007/s13300-023-01503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/23/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Poor metabolic control and excess body weight are frequently present in people with type 2 diabetes (PwT2D). METHODS A systematic literature review was conducted to identify observational studies reporting clinical, economic, and health-related quality of life (HRQoL) outcomes associated with poor metabolic (according to HbA1c, blood pressure [BP] and low density lipoprotein cholesterol [LDL-C] levels) and/or weight control (defined by a body mass index [BMI] ≥ 30 kg/m2) in adults with T2D in Spain, including articles published in either Spanish or English between 2013 and 2022 and conference abstracts from the last 2 years. RESULTS Nine observational studies were included in the analysis. Poor glycemic control (HbA1c ≥ 7%) was associated with cardiovascular disease (CVD), increased requirements for antidiabetic medications, higher and more frequent weight gain, a greater probability of hypoglycemia and dyslipidemia, and worse health-related quality of life (HRQoL). Uncontrolled BP in PwT2D was related with the presence of CVD, worse metabolic control, and higher BMI and abdominal perimeter values. Poor LDL-C control or dyslipidemia was associated with CVD, hypoglycemia, and elevated HbA1c and triglycerides levels. The presence of a BMI ≥ 30 kg/m2 was related to CVD and hypoglycemia, a higher prevalence of metabolic syndrome and worse BP control. Direct medical costs were found to be higher in PwT2D when coexisting with HbA1c levels ≥ 7%, uncontrolled BP or obesity. Increased total costs, including productivity losses, were also detected in those who presented uncontrolled BP and a BMI ≥ 30 kg/m2, and when poor weight control existed together with HbA1c ≥ 8% and poorly controlled BP. CONCLUSION Gathered evidence supports the high clinical, economic and HRQoL burden of poor metabolic and/or weight control in PwT2D in Spain and reinforces the importance of prioritizing its control to reduce the associated burden, at both the individual and healthcare system levels.
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Affiliation(s)
- Antonio Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | | | - Irene Romera
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Luís Lizán
- Outcomes'10, S.L., Castellón de la Plana, Spain
- Departamento de Medicina, Universidad Jaume I, Castellón de la Plana, Spain
| | | | - Silvia Díaz-Cerezo
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
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Ekenberg M, Qvarnström M, Sundström A, Martinell M, Wettermark B. Socioeconomic factors associated with poor medication adherence in patients with type 2 diabetes. Eur J Clin Pharmacol 2024; 80:53-63. [PMID: 37870618 PMCID: PMC10781833 DOI: 10.1007/s00228-023-03571-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE This study aims to determine initiation and persistence for patients with type 2 diabetes receiving their first prescription of an antidiabetic agent and the associations with socioeconomic factors. METHODS A cohort study including 8515 patients with type 2 diabetes who were prescribed their first antidiabetic medication between 2012 and 2019 in Uppsala, Sweden, was followed during 2 years. Medical records were linked to national registers on dispensed drugs and socioeconomic data. Adherence was assessed based on patients' medication claims within 30 days of prescription (initiation) and continued claims after 24 months (persistence). Multivariable logistic regression was used to determine the associations with the socioeconomic factors age, sex, living status, country of birth, education, occupation, and income. RESULTS Within 30 days, 92.4% of the patients claimed their first prescription, and 64.0% were still being dispensed the initially prescribed medication after 24 months. Unemployed patients had lower initiation rates, and women had lower persistence rates. Factors associated with both low initiation and persistence were low income, young or old age, birth outside Europe, and being prescribed other diabetes drugs than metformin monotherapy. CONCLUSION Socioeconomic factors have different impact on the initiation of a new medication and the persistence to treatment in type 2 diabetes. It is important to acknowledge these differences to develop appropriate interventions to improve medication nonadherence.
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Affiliation(s)
- Marie Ekenberg
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden.
| | - Miriam Qvarnström
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Anders Sundström
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Mats Martinell
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Björn Wettermark
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
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Lexomboon D, Tägt M, Nilsson IL, Buhlin K, Häbel H, Sandborgh-Englund G. Effects of primary hyperparathyroidism on oral health. A longitudinal register-based study. Oral Dis 2023; 29:2954-2961. [PMID: 36373895 DOI: 10.1111/odi.14439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/30/2022] [Accepted: 11/09/2022] [Indexed: 10/01/2023]
Abstract
OBJECTIVES To analyze the effects of primary hyperparathyroidism on oral health and to investigate if the effects are linked to severity of the disease. SUBJECTS AND METHODS This prospective cohort study involved 6151 primary hyperparathyroidism patients registered in the Scandinavian Quality Registry of Thyroid, Parathyroid, and Adrenal surgery and the National Cancer Register after parathyroidectomy (exposure) during 2011-2017 (patient cohort) and 60,654 individuals without primary hyperparathyroidism (reference cohort), matched by age, gender, and county of resident at the date of parathyroidectomy. The outcomes were tooth extractions and periodontal interventions. The risk for the outcomes was assessed by Poisson regression models. RESULTS After adjusting for covariates, the patient cohort had a higher incidence rate of tooth extraction during the two-year period after parathyroidectomy (IRR = 1.15; 95% CI = 1.01-1.31), but a lower incidence rate of periodontal interventions during the four- to six-year period after parathyroidectomy (IRR = 0.88; 95% CI = 0.79-0.99). Furthermore, patients with more severe primary hyperparathyroidism were more likely to have tooth extractions and periodontal interventions after parathyroidectomy. CONCLUSIONS The risk of tooth extraction increased slightly during the first two years after parathyroidectomy. Thereafter, the oral health effects subsided. Pre-surgical serum ionized calcium levels and adenoma weight may indicate negative dental outcomes after parathyroidectomy.
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Affiliation(s)
| | - Mina Tägt
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Inga-Lena Nilsson
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kåre Buhlin
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henrike Häbel
- Medical statistics unit, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Sandborgh-Englund
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- Academic Center for Geriatric Dentistry, Stockholm, Sweden
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Li X, Li F, Wang J, van Giessen A, Feenstra TL. Prediction of complications in health economic models of type 2 diabetes: a review of methods used. Acta Diabetol 2023; 60:861-879. [PMID: 36867279 PMCID: PMC10198865 DOI: 10.1007/s00592-023-02045-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/31/2023] [Indexed: 03/04/2023]
Abstract
AIM Diabetes health economic (HE) models play important roles in decision making. For most HE models of diabetes 2 diabetes (T2D), the core model concerns the prediction of complications. However, reviews of HE models pay little attention to the incorporation of prediction models. The objective of the current review is to investigate how prediction models have been incorporated into HE models of T2D and to identify challenges and possible solutions. METHODS PubMed, Web of Science, Embase, and Cochrane were searched from January 1, 1997, to November 15, 2022, to identify published HE models for T2D. All models that participated in The Mount Hood Diabetes Simulation Modeling Database or previous challenges were manually searched. Data extraction was performed by two independent authors. Characteristics of HE models, their underlying prediction models, and methods of incorporating prediction models were investigated. RESULTS The scoping review identified 34 HE models, including a continuous-time object-oriented model (n = 1), discrete-time state transition models (n = 18), and discrete-time discrete event simulation models (n = 15). Published prediction models were often applied to simulate complication risks, such as the UKPDS (n = 20), Framingham (n = 7), BRAVO (n = 2), NDR (n = 2), and RECODe (n = 2). Four methods were identified to combine interdependent prediction models for different complications, including random order evaluation (n = 12), simultaneous evaluation (n = 4), the 'sunflower method' (n = 3), and pre-defined order (n = 1). The remaining studies did not consider interdependency or reported unclearly. CONCLUSIONS The methodology of integrating prediction models in HE models requires further attention, especially regarding how prediction models are selected, adjusted, and ordered.
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Affiliation(s)
- Xinyu Li
- Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, A. Deusinglaan1, 9713AV, Groningen, The Netherlands.
| | - Fang Li
- Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, A. Deusinglaan1, 9713AV, Groningen, The Netherlands
| | - Junfeng Wang
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Anoukh van Giessen
- Expertise Center for Methodology and Information Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Talitha L Feenstra
- Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, A. Deusinglaan1, 9713AV, Groningen, The Netherlands
- Center for Nutrition, Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Quan J, Zhao Z, Wang L, Ng CS, Kwok HH, Zhang M, Zhou S, Ye J, Ong XJ, Ma R, Leung GM, Eggleston K, Zhou M. Potential health and economic impact associated with achieving risk factor control in Chinese adults with diabetes: a microsimulation modelling study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 33:100690. [PMID: 37181534 PMCID: PMC10166995 DOI: 10.1016/j.lanwpc.2023.100690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/30/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
Background The prevalence of diabetes has risen sharply in China. Improving modifiable risk factors such as glycaemia and blood pressure could substantially reduce disease burden and treatment costs to achieve a healthier China by 2030. Methods We used a nationally representative population-based survey of adults with diabetes in 31 provinces in mainland China to assess the prevalence of risk factor control. We adopted a microsimulation approach to estimate the impact of improved control of blood pressure and glycaemia on mortality, quality-adjusted life-years (QALYs), and healthcare cost. We applied the validated CHIME diabetes outcomes model over a 10-year time horizon. Baseline scenario of status quo was evaluated against alternative strategies based on World Health Organization and Chinese Diabetes Society guidelines. Findings Among 24,319 survey participants with diabetes (age 30-70), 69.1% (95% CI: 67.7-70.5) achieved optimal diabetes control (HbA1c <7% [53 mmol/mol]), 27.7% [26.1-29.3] achieved blood pressure control (<130/80 mmHg) and 20.1% (18.6-21.6) achieved both targets. Achieving 70% control rate for people with diabetes could reduce deaths before age 70 by 7.1% (5.7-8.7), reduce medical costs by 14.9% (12.3-18.0), and gain 50.4 QALYs (44.8-56.0) per 1000 people over 10 years compared to the baseline status quo. The largest health gains were for strategies including strict blood pressure control of 130/80 mmHg, particularly in rural areas. Interpretation Based on a nationally representative survey, few adults with diabetes in China achieved optimal control of glycaemia and blood pressure. Substantial health gains and economic savings are potentially achievable with better risk factor control especially in rural settings. Funding Chinese Central Government, Research Grants Council of the Hong Kong Special Administrative Region, China [27112518].
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Affiliation(s)
- Jianchao Quan
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Zhenping Zhao
- The National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Xicheng District, 100050, Beijing, China
| | - Limin Wang
- The National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Xicheng District, 100050, Beijing, China
| | - Carmen S. Ng
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Harley H.Y. Kwok
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mei Zhang
- The National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Xicheng District, 100050, Beijing, China
| | - Sunyue Zhou
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jiaxi Ye
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xin Jiong Ong
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Robyn Ma
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Gabriel M. Leung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong SAR, China
| | - Karen Eggleston
- Stanford University, Stanford, CA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
| | - Maigeng Zhou
- The National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Xicheng District, 100050, Beijing, China
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Moes RGJ, Huisman EL, Malkin SJP, Hunt B. Evaluating the Clinical and Economic Outcomes Associated with Poor Glycemic Control in People with Type 1 Diabetes in the Netherlands. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:87-96. [PMID: 36778040 PMCID: PMC9910197 DOI: 10.2147/ceor.s391626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Achieving and maintaining glycemic control is the cornerstone of type 1 diabetes management, with the aim of reducing the incidence of diabetes-related complications over the long term. However, many individuals fail to reach glycemic targets. The present study evaluated the clinical and economic burden associated with poor glycemic control in people with type 1 diabetes in the Netherlands, and the improvements in outcomes that can be achieved by improving treatment. Methods Immediate glycemic control, defined as achieving a glycated hemoglobin (HbA1c) target of 7.0% at the start of the analysis, was compared with delays in achieving control of 1, 3 and 7 years, with outcomes projected using the IQVIA CORE Diabetes Model. Projections of life expectancy, quality-adjusted life expectancy, and direct and indirect costs (expressed in 2021 euros [EUR]) were made at a patient level and extrapolated to the population level. Results Improving HbA1c from 8.0% to 7.0% and 9.0% to 7.0% resulted in gains of up to 0.66 and 1.37 quality-adjusted life years (QALYs) per patient over a lifetime, respectively. At a population level, achieving immediate glycemic control was associated with gains of 9438, 27,171 and 72,717 QALYs and cost savings of up to EUR 224 million, EUR 556 million and EUR 1.3 billion compared with remaining in poor control for 1, 3 and 7 years, respectively. Conclusion The clinical and economic burden of poor glycemic control in people with type 1 diabetes in the Netherlands was projected to be substantial, but considerable gains in quality-adjusted life expectancy and cost savings could be achieved through early and effective treatment.
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Affiliation(s)
| | | | | | - Barnaby Hunt
- Ossian Health Economics and Communications, Basel, Switzerland
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Alieva A, Alimov A, Khaidarova F, Ismailov S, Rakhimova G, Nazhmutdinova D, Shagazatova B, Tsareva V. Assessing the Effectiveness of Type 2 Diabetes Screening in the Republic of Uzbekistan. Int J Endocrinol Metab 2022; 20:e124036. [PMID: 36714191 PMCID: PMC9871961 DOI: 10.5812/ijem-124036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 09/13/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) screening should be performed continuously at the primary care level in order to prevent disabling complications. Due to the high prevalence of undiagnosed T2D in the Republic of Uzbekistan, a decision was made to implement a nationwide screening program for T2D. OBJECTIVES The current study, taking into account the limited resources of Uzbekistan's health care system, aimed to offer the most effective, simple, and economical option required for the actual implementation of regular T2D screening in the country's primary care. METHODS The screening was conducted from December 2018 to March 2019. There were four different scenarios, which differed in terms of eligibility criteria and the methodology adopted for detecting dysglycemia. RESULTS A total of 2,430 patients were examined in four months. The T2D diagnosis was established by an endocrinologist in 9.3% of the cases with one eligibility criterion and 15.9% of the cases with three eligibility criteria. The diagnosis of T2D was established by an endocrinologist in 11.7% of the cases with HbA1c screening and 13.5% of the cases with glucose screening. CONCLUSIONS The screening was feasible in Uzbekistan only in limited conditions. The reasonable strategy was found to be the screening for incidental glycemia in all patients with at least one T2D risk factor. It was recommended that patients with incidental glycemia ≥ 7.8 mmol/L should be tested for fasting glycemia.
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Affiliation(s)
- Anna Alieva
- Deputy Chief Physician, Republican Specialized Scientific and Practical Medical Center of Endocrinology Named After Academician Ya. Kh. Turakulov of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
- Corresponding Author: Deputy Chief Physician, Republican Specialized Scientific and Practical Medical Center of Endocrinology Named After Academician Ya. Kh. Turakulov of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan.
| | - Anvar Alimov
- Deputy Minister, Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Feruza Khaidarova
- Deputy Director, Republican Specialized Scientific and Practical Medical Center of Endocrinology Named After Academician Ya. Kh. Turakulov of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Saidiganikhoja Ismailov
- Head of the Department of Endocrinology with Pediatric Endocrinology, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
| | - Gulnara Rakhimova
- Head of the Department of Endocrinology, Center for the Development of Professional Qualifications of Medical Workers, Tashkent, Uzbekistan
| | - Dilorom Nazhmutdinova
- Head of the Department of Endocrinology, Tashkent Medical Academy, Tashkent, Uzbekistan
| | - Barno Shagazatova
- Department of Internal Medicine, Tashkent Medical Academy, Tashkent, Uzbekistan
| | - Victoria Tsareva
- Chief Physician, Tashkent City Endocrinological Dispensary, Tashkent, Uzbekistan
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Peng ZY, Yang CT, Ou HT, Kuo S. Cost-effectiveness of sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors among patients with type 2 diabetes with and without established cardiovascular diseases: A model-based simulation analysis using 10-year real-world data and targeted literature review. Diabetes Obes Metab 2022; 24:1328-1337. [PMID: 35373898 DOI: 10.1111/dom.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/11/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
AIM We conducted a model-based economic analysis of sodium-glucose cotransporter-2 inhibitors (SGLT2is) versus dipeptidyl peptidase-4 inhibitors (DPP4is) in patients with type 2 diabetes (T2D), with and without established cardiovascular diseases (CVDs), using 10-year real-world data. MATERIALS AND METHODS A Markov model was utilized to estimate healthcare costs and quality-adjusted life-years (QALYs) over a 10-year simulation time horizon from a healthcare sector perspective, with both costs and QALYs discounted at 3% annually. Model inputs were derived from analyses of Taiwan's National Health Insurance Research Database or published studies of Taiwanese populations. The primary outcome measure was the incremental cost-effectiveness ratios (ICERs). Incorporated with our study findings, a targeted literature review was conducted to synthesize updated evidence on the cost-effectiveness of SGLT2is versus DPP4is. RESULTS Over 10 years, use of SGLT2is versus DPP4is yielded ICERs of $3244 and $4186 per QALY gained for patients with T2D, with and without established CVDs, respectively. Results were robust across a series of sensitivity and scenario analyses, showing ICERs between $-1074 (cost-saving) and $8467 per QALY gained for patients with T2D with established CVDs and between $369 and $37 122 per QALY gained for patients with T2D without established CVDs. CONCLUSIONS Use of SGLT2is versus DPP4is was highly cost-effective for patients with T2D regardless of their CVD history in real-world clinical practice. Our results extend current evidence by showing SGLT2is as an economically rational alternative over DPP4is for T2D treatment in routine care. Future research is warranted to explore the heterogeneous economic benefits of SGLT2is given diverse patient characteristics in clinical settings.
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Affiliation(s)
- Zi-Yang Peng
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Ting Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shihchen Kuo
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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12
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Kotsopoulos N, Connolly MP, Willis M, Nilsson A, Ericsson Å, Baker‐Knight J. The public economic burden of suboptimal type 2 diabetes control upon taxpayers in Sweden: Looking beyond health costs. Diabetes Obes Metab 2022; 24:1038-1046. [PMID: 35137507 PMCID: PMC9313875 DOI: 10.1111/dom.14667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 12/24/2022]
Abstract
AIM To estimate the fiscal burden for taxpayers in Sweden associated with type 2 diabetes (T2D) attributed to diabetes-related complications in patients failing to meet HbA1c targets. MATERIAL AND METHODS We developed a public economic framework to assess how changes in diabetes-related complications influenced projected tax contributions and government disability payments for people with T2D. The analysis applied accepted disease-modelling practices to estimate different rates of diabetes-related complications based on an HbA1c of 6.9% (52 mmol/mol) and of 6.0% (42 mmol/mol). We adjusted the employment activity rates for those experiencing T2D-related events, applying age-specific earnings to estimate lifetime tax losses. Furthermore, the likelihood of receiving payments for health-related employment inactivity was estimated. Direct healthcare costs are excluded from this analysis. RESULTS The estimated per person earnings loss for immediate and delayed HbA1c control was Swedish krona (SEK) 42 299 and SEK 44 157, respectively, over 10 years. The lost employment activity of people with T2D translates to lost tax revenues of SEK 23 265 and SEK 24 287 for immediate and delayed control, respectively. The estimated difference in disability payments was SEK 538. Combining the tax revenue loss and excess disability payments defines the broader fiscal costs, where we observe combined fiscal losses that favour immediate and sustained control by SEK 1560 over 10 years. CONCLUSIONS We show that conducting fiscal analysis of diabetes interventions offers an enriched perspective capturing a range of costs that fall on government in relation to lost tax revenue and disability payments. Tax-financed health systems may benefit from broadening the consideration of costs and benefits when evaluating new interventions and treatment practices.
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Affiliation(s)
- Nikolaos Kotsopoulos
- Global Market Access SolutionsHealth Economics UnitSt‐PrexSwitzerland
- Department of Economics, UoA MBAUniversity of AthensAthensGreece
| | - Mark P. Connolly
- Global Market Access SolutionsHealth Economics UnitSt‐PrexSwitzerland
- University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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Hellgren M, Svensson A, Franzén S, Ericsson Å, Gudbjörnsdottir S, Ekström N, Bertilsson R, Valentine W, Malkin S. The burden of poor glycaemic control in people with newly diagnosed type 2 diabetes in Sweden: A health economic modelling analysis based on nationwide data. Diabetes Obes Metab 2021; 23:1604-1613. [PMID: 33729661 PMCID: PMC8360155 DOI: 10.1111/dom.14376] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/03/2021] [Accepted: 03/14/2021] [Indexed: 12/11/2022]
Abstract
AIM To evaluate the economic and clinical burden associated with poor glycaemic control in Sweden, in people with type 2 diabetes (T2D) initiating first-line glucose-lowering therapy. MATERIALS AND METHODS Population data were obtained from Swedish national registers. Immediate glycaemic control was compared with delays in achieving control of 1 and 3 years, with outcomes projected over 3, 10 and 50 years in the validated IQVIA CORE Diabetes Model. Glycaemic control was defined as glycated haemoglobin (HbA1c) targets of 52, 48 and 42 mmol/mol, as recommended in Swedish guidelines, according to age and disease duration. Costs (expressed in 2019 Swedish krona [SEK]) were accounted from a Swedish societal perspective. RESULTS Immediate glycaemic control was associated with population-level cost savings of up to SEK 279 million and SEK 673 million versus delays of 1 and 3 years, respectively, as well as small population-level life expectancy benefits of up to 1305 and 2590 life years gained. Reduced levels of burden were a result of lower incidence and delayed time to onset of diabetes-related complications. CONCLUSIONS Even in people with T2D initiating first-line glucose-lowering therapy, the economic burden of poor glycaemic control in Sweden is substantial, but could be reduced by early and effective treatment to achieve glycaemic targets.
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Affiliation(s)
- Margareta Hellgren
- The Skaraborg InstituteSkövdeSweden
- Department of Public Health and Community Medicine/Primary Health CareSahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Ann‐Marie Svensson
- The Swedish National Diabetes Register, Västra GötalandsregionenGothenburgSweden
- Department of Molecular and Clinical Medicine, Institute of MedicineUniversity of GothenburgGothenburgSweden
| | - Stefan Franzén
- Register Centrum Västra GötalandGöteborgSweden
- School of Public Health and Community MedicineInstitute of Medicine, Sahlgrenska Academy, Gothenburg UniversityGothenburgSweden
| | | | - Soffia Gudbjörnsdottir
- The Swedish National Diabetes Register, Västra GötalandsregionenGothenburgSweden
- Department of Molecular and Clinical Medicine, Institute of MedicineUniversity of GothenburgGothenburgSweden
| | | | | | | | - Samuel Malkin
- Ossian Health Economics and CommunicationsBaselSwitzerland
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