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Presentation by Susanne Sebens Conni Christiansen Niels Lund 10 June 2008

Using UK Prospective Diabetes Study (UKPDS) Outcomes Model to Assess Different Approaches to Type 2 Diabetes Management at Diagnosis. Presentation by Susanne Sebens Conni Christiansen Niels Lund 10 June 2008. Purpose of analysis.

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Presentation by Susanne Sebens Conni Christiansen Niels Lund 10 June 2008

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  1. Using UK Prospective Diabetes Study (UKPDS) Outcomes Model to Assess Different Approaches to Type 2 Diabetes Management at Diagnosis Presentation by Susanne Sebens Conni Christiansen Niels Lund 10 June 2008

  2. Purpose of analysis • To assess the effect on life expectancy, quality of life expectancy and total direct cost implications of different intervention at diagnosis for type 2 diabetes patients in the United Kingdom • Interventions analyzed include: • smoke cessation with different success • diet and exercise with different success • oral anti-diabetic drug • combinations of the above with different success

  3. Agenda • Quality of life and cost of complication for diabetes patients in general • Overview of UK Prospective Diabetes Survey (UKPDS) • Modeling of various scenarios for newly diagnosed diabetes patients • Discussion

  4. Quality-Adjusted Life Years (QALY) for diabetes complications • Patient quality of life (QoL) is expressed as a health utility or quality-adjusted life year score QALY score Perfect health 1 0.814 Diabetes with no complications Severe vision loss 0.734 0.680 Lower extremity amputation Hemodialysis 0.490 0 Death Clarke et al. (UKPDS 62) Med Decis Making 2002;22(4):340-49Tengs et al. Med Care 2000;38(6):583-637

  5. Diabetes Costs are Largely Dependent on Complications €5,642 • Annual cost per patient with type 2 diabetes is dependent on complication status • Complications manifest themselves after decades, not years 4.1-fold increase €3,437 €3,355 2.5-fold increase 2.4-fold increase €1,723 €1,373 1.3-fold increase No diabetes Diabetes, nocomplications Diabetes,microvascularcomplications Diabetes,macrovascularcomplications Diabetes, micro-and macrovascularcomplications CODE-2 Study. Liebl et al. Dtsch Med Wochenschr. 2001 May 18;126(20):585-9

  6. United Kingdom Prospective Diabetes Study Outcomes Model A comprehensive model for estimating health outcomes for people with type 2 diabetes, that: uses long-term (median 10.3 years) follow-up data for 3,642 diabetes patients in the UK predicts risk of major diabetes-related complications captures time varying risk factors such as blood sugar (HbA1c) and history of previous complications estimates lifetime health outcomes of alternative diabetes management strategies in terms of event rates and life expectancy & quality adjusted life expectancy A probabilistic discrete-time (Markov-like) model with annual cycles Made in Microsoft Excel

  7. Summary of model equations

  8. Algorithm of model process

  9. Risk factor progression • Separate equations to represent the time paths from diagnosis of diabetes of four risk factors : • Blood sugar (HbA1c) • Systolic Blood Pressure (SBP) • Cholesterol (Ratio of Total: HDL) • Smoking status • Current blood sugar (HbA1c) is determined by the last value of HbA1c, value at diagnosis, years from diagnosis and an indicator variable to capture the decline in HbA1c following the initial period of treatment

  10. Time path of blood sugar (HbA1c)

  11. Quality of life The potential impact of complications on quality of life is important Quality of life survey was administered in 1996-7 to 3,667 UKPDS patients EQ-5D survey completed by the patient when they attended UKPDS clinics 3,302 survey forms returned of which 3,192 were fully completed

  12. EQ-5D: Self description Five domains Mobility Self care Usual activities Pain/ discomfort Anxiety/ depression Three levels for each domain: No problem Some, or moderate problems Unable, or extreme problems

  13. Baseline assumption for analysis • Two individuals (male and female): • BMI = 30, age = 55, SBP = 160, HbA1c = 9.0%, Cholesterol = 7 mmol/L, HDL = 3 mmol/L • No pre-existing conditions related to diabetes complications (diabetic ulcers, heart failure, stroke etc.) • Both patients are smokers • Time horizon = 20 years. • Number of bootstraps per patient = 100 • Discounting rate: 3.5% for both benefits and costs • UK 2006 cost (compiled from UKPDS and from BMJ May article) • Societal perspective based on direct costs only

  14. Intervention scenarios

  15. Years gained from intervention

  16. Incremental costs by intervention

  17. ICER by intervention

  18. ICER by intervention with ineffective diet and exercise

  19. Conclusions from analysis • Smoke cessation is always a good deal: Will in some case even save money for society. • Diet and exercise offers good results but is contingent on compliance: With poor compliance cost effectiveness worsens considerably  alternative treatments should be considered • Metformin OAD is also a good deal on its own: Consider whether it should be first line treatment in stead of diet and exercise assuming that patients do not exercise and eat healthy enough

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