A New Type 2 Diabetes Microsimulation Model to Estimate Long-Term Health Outcomes, Costs, and Cost-Effectiveness

This study aimed to develop a microsimulation model to estimate the health effects, costs, and cost-effectiveness of public health and clinical interventions for preventing/managing type 2 diabetes. We combined newly developed equations for complications, mortality, risk factor progression, patient...

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Vydáno v:Value in health Ročník 26; číslo 9; s. 1372 - 1380
Hlavní autoři: Hoerger, Thomas J., Hilscher, Rainer, Neuwahl, Simon, Kaufmann, Matthew B., Shao, Hui, Laxy, Michael, Cheng, Yiling J., Benoit, Stephen, Chen, Haiying, Anderson, Andrea, Craven, Tim, Yang, Wenya, Cintina, Inna, Staimez, Lisa, Zhang, Ping
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Elsevier Inc 01.09.2023
Témata:
Adult
Cost-Benefit Analysis
diabetes
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - epidemiology
Diabetes Mellitus, Type 2 - therapy
Glycated Hemoglobin
Humans
Internal Medicine
microsimulation
Middle Aged
Outcome Assessment, Health Care
probabilistic sensitivity analysis
Public Health
Quality-Adjusted Life Years
risk equations
United States - epidemiology
United States
probabilistic sensitivity analysis
risk equations
diabetes
microsimulation
ISSN:1098-3015, 1524-4733, 1524-4733
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Popis
Shrnutí:This study aimed to develop a microsimulation model to estimate the health effects, costs, and cost-effectiveness of public health and clinical interventions for preventing/managing type 2 diabetes. We combined newly developed equations for complications, mortality, risk factor progression, patient utility, and cost—all based on US studies—in a microsimulation model. We performed internal and external validation of the model. To demonstrate the model’s utility, we predicted remaining life-years, quality-adjusted life-years (QALYs), and lifetime medical cost for a representative cohort of 10 000 US adults with type 2 diabetes. We then estimated the cost-effectiveness of reducing hemoglobin A1c from 9% to 7% among adults with type 2 diabetes, using low-cost, generic, oral medications. The model performed well in internal validation; the average absolute difference between simulated and observed incidence for 17 complications was < 8%. In external validation, the model was better at predicting outcomes in clinical trials than in observational studies. The cohort of US adults with type 2 diabetes was projected to have an average of 19.95 remaining life-years (from mean age 61), incur $187 729 in discounted medical costs, and accrue 8.79 discounted QALYs. The intervention to reduce hemoglobin A1c increased medical costs by $1256 and QALYs by 0.39, yielding an incremental cost-effectiveness ratio of $9103 per QALY. Using equations exclusively derived from US studies, this new microsimulation model achieves good prediction accuracy in US populations. The model can be used to estimate the long-term health impact, costs, and cost-effectiveness of interventions for type 2 diabetes in the United States. •Existing type 2 simulation models implement risk equations derived from UK data. This model is based on newly derived risk equations developed for the United States. This model can be used to predict remaining life-years, costs, and quality-adjusted life-years for different cohorts of type 2 patients.•Existing type 2 simulation models are limited in their extendability. This microsimulation introduces a highly modular architecture that allows for easy addition of new modules (types of diabetes, complications). A wide variety of interventions can be implemented, informing policy decision making.
Bibliografie:ObjectType-Article-1
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Author Contributions: Concept and design: Hoerger, Hilscher, Kaufmann, Shao, Laxy, Cheng, Benoit, Yang, Staimez, Zhang
Critical revision of article for important intellectual content: Hoerger, Hilscher, Shao, Laxy, Cheng, Benoit, Chen, Anderson, Yang, Staimez, Zhang
Statistical analysis: Hoerger, Neuwahl, Kaufmann, Anderson, Craven, Cintina
Provision of study materials or patients: Hoerger
Acquisition of data: Hoerger, Neuwahl, Chen, Anderson, Yang, Staimez
A complete list of the authors and members of the Look AHEAD trial can be found in the Online-only Supplemental Materials.
Analysis and interpretation of data: Hoerger, Neuwahl, Kaufmann, Laxy, Benoit, Chen, Craven, Yang, Cintina, Staimez
Design and implementation of microsimulation: Hilscher
Obtaining funding: Hoerger
Supervision: Hoerger, Shao, Yang
Drafting of the article: Hoerger, Shao, Laxy, Cheng, Craven, Yang, Cintina, Zhang
Administrative, technical, or logistic support: Hoerger, Neuwahl
ISSN:1098-3015
1524-4733
1524-4733
DOI:10.1016/j.jval.2023.05.013