American Diabetes Association
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Patient Health Utility Equations for a Type 2 Diabetes Model

Version 2 2021-01-11, 09:13
Version 1 2020-12-04, 22:52
posted on 2021-01-11, 09:13 authored by Simon J. Neuwahl, Ping Zhang, Haiying Chen, Hui Shao, Michael Laxy, Andrea M. Anderson, Timothy E. Craven, Thomas J. Hoerger, the Look AHEAD Research Group
Objective: To estimate the health utility impact of diabetes-related complications in a large, longitudinal U.S. sample of people with type 2 diabetes.

Research Design and Methods: We combined Health Utility Index-3 data on patients with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Action for Health in Diabetes (Look AHEAD) trials and their follow-on studies. Complications were classified as events if they occurred in the year preceding the utility measurement; otherwise, they were classified as a history of the complication. We estimated utility decrements associated with complications using a fixed-effects regression model.

Results: Our sample included 15,252 persons with an average follow-up of 8.2 years and a total of 128,873 person-visit observations. The largest, statistically significant (p < 0.05) health utility decrements were for stroke (event: −0.109; history: −0.051), amputation (event: −0.092; history: −0.150), congestive heart failure (CHF; event: −0.051; history: −0.041), dialysis (event: −0.039), estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 (event: −0.043; history: −0.025), angina (history: −0.028), and myocardial infarction (MI) (event: −0.028). There were smaller effects for laser photocoagulation, and eGFR < 60 mL/min/1.73 m2. Decrements for dialysis history, angina event, MI history, revascularization event, revascularization history, laser photocoagulation event, and hypoglycemia were not significant (p >= 0.05)

Conclusions: Using a large study sample and a longitudinal design, our estimated health utility scores are expected to be largely unbiased. Estimates can be used to describe the health utility impact of diabetes complications, improve cost-effectiveness models, and inform diabetes policies.


This model and manuscript were developed by RTI International under contract number 200-2016-92270 from the Centers for Disease Control and Prevention. Manuscript contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention, the Department of Health and Human Services, or the U.S. government.


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