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Benchmarking the cost-effectiveness of interventions delaying diabetes: a simulation study based on NAVIGATOR data

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posted on 12.08.2020 by Jose Leal, Shelby D Reed, Rishi Patel, Oliver Rivero-Arias, Yanhong Li, Kevin A Schulman, Robert M Califf, Rury Holman, Alastair M Gray
Objective: To estimate using the United Kingdom Prospective Diabetes Study Outcomes Model Version 2 (UKPDS-OM2) the impact of delaying type 2 diabetes onset on costs and quality-adjusted life expectancy using trial participants who developed diabetes in the NAVIGATOR study.

Research design and methods: We simulated the impact of delaying diabetes onset by one to nine years, utilising data from the 3058 of 9306 NAVIGATOR trial participants who developed type 2 diabetes. Costs and utility weights associated with diabetes and diabetes-related complications were obtained for US and UK settings, with costs expressed in 2017 values. We estimated discounted lifetime costs and quality-adjusted life years (QALYs) with 95% confidence intervals.

Results: Gains in QALYs increased from 0.02 (95% CI: 0.01, 0.03; US setting) to 0.15 (95% CI: 0.11, 0.20; US setting) as the imposed time to diabetes onset was increased from one to nine years, respectively. Savings in complication costs increased from $1,388 (95%CI: $1,092, $1,669) for one-year delay to $8,437 (95% CI: $5603, $8630) for a delay of nine years. Interventions costing up to $567-$2,680 and £201-£947 per year would be cost-effective at $100,000 per QALY and £20,000 per QALY thresholds in the US and UK, respectively, as the modelled delay in diabetes onset was increased from one to nine years.

Conclusions: Simulating a hypothetical diabetes-delaying intervention provides guidance concerning the maximum cost and minimum delay in diabetes onset needed to be cost-effective. These results can inform the ongoing debate about diabetes prevention strategies and the design of future intervention studies.

Funding

Analyses undertaken at the Health Economics Research Centre were supported by a research grant made by Novartis Pharma to the University of Oxford and Duke University. J.L. acknowledges support from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115881 (RHAPSODY). A.M.G. is partly funded by the NIHR Biomedical Research Centre, Oxford, UK.

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