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1.
Diabetes Obes Metab ; 9(1): 103-13, 2007 Jan.
Article in English | MEDLINE | ID: mdl-17199725

ABSTRACT

OBJECTIVES: To project the long-term clinical and economic outcomes of treatment with biphasic insulin aspart 30 (BIAsp 70/30, 30% soluble and 70% protaminated insulin aspart) vs. insulin glargine in insulin-naïve type 2 diabetes patients failing to achieve glycemic control with oral antidiabetic agents alone (OADs). METHODS: Baseline patient characteristics and treatment effect data from the recent 'INITIATE' clinical trial served as input to a peer-reviewed, validated Markov/Monte-Carlo simulation model. INITIATE demonstrated improvements in HbA1c favouring BIAsp 70/30 vs. glargine (-0.43%; p < 0.005) and greater efficacy in reaching glycaemic targets among patients poorly controlled on OAD therapy. Effects on life expectancy (LE), quality-adjusted life expectancy (QALE), cumulative incidence of diabetes-related complications and direct medical costs (2004 USD) were projected over 35 years. Clinical outcomes and costs were discounted at a rate of 3.0% per annum. Sensitivity analyses were performed. RESULTS: Improvements in glycaemic control were projected to lead to gains in LE (0.19 +/- 0.24 years) and QALE (0.19 +/- 0.17 years) favouring BIAsp 70/30 vs. glargine. Treatment with BIAsp 70/30 was also associated with reductions in the cumulative incidences of diabetes-related complications, notably in renal and retinal conditions. The incremental cost-effectiveness ratio was $46 533 per quality-adjusted life year gained with BIAsp 70/30 vs. glargine (for patients with baseline HbA1c >/= 8.5%, it was $34 916). Total lifetime costs were compared to efficacy rates in both arms as a ratio, which revealed that the lifetime cost per patient treated successfully to target HbA1c levels of <7.0% and

Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/therapeutic use , Insulin/analogs & derivatives , Administration, Oral , Adult , Aged , Biphasic Insulins , Cost-Benefit Analysis , Diabetes Complications/economics , Diabetes Complications/prevention & control , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/economics , Epidemiologic Methods , Female , Glycated Hemoglobin/metabolism , Health Care Costs/statistics & numerical data , Humans , Hypoglycemic Agents/economics , Insulin/economics , Insulin/therapeutic use , Insulin Aspart , Insulin Glargine , Insulin, Isophane , Insulin, Long-Acting , Male , Middle Aged , Treatment Failure , Treatment Outcome
2.
Int J Clin Pract ; 60(9): 1138-45, 2006 Sep.
Article in English | MEDLINE | ID: mdl-16939559

ABSTRACT

To project the long-term clinical and cost outcomes that accompany predefined improvements in glycaemic control in patients with type 2 diabetes. A peer-reviewed, validated, non-product-specific Markov model of type 2 diabetes was used to project the long-term clinical and cost outcomes associated with three HbA1c reduction scenarios (vs. no reduction): (i) decreasing mean HbA1c from 9.5% to 8.0%; (ii) from 8.0% to 7.0%; and (iii) from 7.0% to 6.5%. A typical baseline US type 2 diabetes cohort derived from National Health and Nutrition Examination Survey data was simulated over a lifetime horizon (35 years). Incidence of diabetes-related complications and costs (2005 USD) were accounted based on published data. Discount rates (3% per annum) were applied to clinical benefits and costs. Sensitivity analyses were performed. Stepwise reductions in HbA1c as an independent variable correlated with delayed time to diabetes-related complications and a reduced cumulative incidence of complications, including cardiovascular, renal and neurologic comorbidities. Related costs also decreased. Reductions in both poorly- (9.5-8.0%) and better-controlled (7.0-6.5%) patients produced incremental gains in undiscounted life expectancy (LE) [1.06 (0.31) and 0.32 (0.34) years [mean (SD)], respectively]. Similar improvement patterns were observed in quality-adjusted life expectancy (QALE). Benefits from sequential reduction scenarios, when aggregated, exhibited the most dramatic effect. Improved glycaemic control was associated with reductions in complication rates and costs, as well as increased LE and QALE among type 2 patients. These data illustrate the long-term importance of reaching normoglycaemia and support intensified HbA1c control as a cornerstone of effective long-term type 2 diabetes management.


Subject(s)
Blood Glucose/metabolism , Diabetes Complications/prevention & control , Diabetes Mellitus, Type 2/therapy , Glycated Hemoglobin/metabolism , Costs and Cost Analysis , Diabetes Complications/blood , Diabetes Complications/economics , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/economics , Humans , Hypoglycemia/etiology , Hypoglycemia/prevention & control , Life Expectancy , Quality-Adjusted Life Years
3.
Acta Paediatr Suppl ; 88(431): 79-86, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10588275

ABSTRACT

This study is an economic evaluation of three treatment strategies for vesico-ureteric reflux in children: neo-implantation; subureteric injection; and antibacterial prophylaxis. Cost-analysis was used to compare the strategies, implying that the differences in benefits between them were not measured. Direct and indirect costs are included, taking the analytical viewpoint of the community. For the surgical strategies, data from four different hospitals in Sweden were used, and for the prophylactic strategy, data was gathered through a survey of 31 hospitals. The treatment strategies were ranked in the following order (bilateral reflux in parentheses): (i) subureteric injection SEK 25,000-28,000 (26,000-36,000); (ii) antibacterial prophylaxis SEK 16,000-36,000; and (iii) neo-implantation SEK 65,000-90,000 (72,000-95,000).


Subject(s)
Health Care Costs/statistics & numerical data , Vesico-Ureteral Reflux/economics , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Biocompatible Materials/economics , Biocompatible Materials/therapeutic use , Child , Collagen/economics , Collagen/therapeutic use , Cost of Illness , Direct Service Costs/statistics & numerical data , Evaluation Studies as Topic , Health Expenditures/statistics & numerical data , Hospital Costs/statistics & numerical data , Humans , Injections/economics , Length of Stay/economics , Models, Economic , Prosthesis Implantation/economics , Sweden , Vesico-Ureteral Reflux/drug therapy , Vesico-Ureteral Reflux/surgery
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