American Diabetes Association
Browse
Online_appendix_14June2020.pdf (850.3 kB)

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

Download (850.3 kB)
figure
posted on 2020-08-12, 16:36 authored 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.

History

Usage metrics

    Diabetes Care

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC