PMID- 25596535
OWN - NLM
STAT- MEDLINE
DCOM- 20160316
LR  - 20221207
IS  - 1552-681X (Electronic)
IS  - 0272-989X (Linking)
VI  - 35
IP  - 5
DP  - 2015 Jul
TI  - Estimating Cost-Effectiveness in Type 2 Diabetes: The Impact of Treatment 
      Guidelines and Therapy Duration.
PG  - 660-70
LID - 10.1177/0272989X14565821 [doi]
AB  - OBJECTIVES: Type 2 diabetes mellitus (T2DM) clinical guidelines focus on 
      optimizing glucose control, with therapy escalation classically initiated within 
      a "failure-based" regimen. Within many diabetes models, HbA1c therapy escalation 
      thresholds play a pivotal role, controlling duration of therapy and, 
      consequently, incremental costs and benefits. The objective of this study was to 
      assess the relationship between therapy escalation threshold and time to therapy 
      escalation on predicted cost-effectiveness of T2DM treatments. METHODS: This 
      study used the Cardiff Diabetes Model to illustrate the relationship between 
      costs and health outcomes associated with first-, second-, and third-line therapy 
      as a function of time on each. Data from routine clinical practice were used to 
      contrast predicted costs and health outcomes associated with guideline therapy 
      escalation thresholds compared with clinical practice. The impact of baseline 
      HbA1c and therapy escalation thresholds on cost-effectiveness was investigated, 
      comparing a sodium/glucose cotransporter 2 inhibitor v. sulfonylurea added to 
      metformin monotherapy. RESULTS: Lower thresholds are associated with a shorter 
      time spent on monotherapy, ranging from 1.1 years (escalation at 6.5%) to 13 
      years (escalation at 9.0%) and an increase in total lifetime cost of therapy. 
      Treatment-related disutility is minimized with higher thresholds because 
      progression to insulin is delayed. Using metformin combined with either 
      dapagliflozin or a sulfonylurea to illustrate lower baseline HbA1c and/or higher 
      therapy escalation thresholds was associated with increased cost-effectiveness 
      ratios, driven by a longer duration of therapy. DISCUSSION: A marked difference 
      in treatment cost-effectiveness was demonstrated when comparing routine clinical 
      practice with guideline-advocated therapy escalation. This is important to both 
      health care professionals and the wider health economic community with respect to 
      understanding the true cost-effectiveness profile of any particular T2DM therapy 
      option.
CI  - (c) The Author(s) 2015.
FAU - McEwan, Phil
AU  - McEwan P
AD  - Swansea Centre for Health Economics, Swansea University, Wales, UK (PCM, HB)
AD  - Health Economics & Outcomes Research Ltd., Wales, UK (PCM, JG, TW)
FAU - Gordon, Jason
AU  - Gordon J
AD  - Health Economics & Outcomes Research Ltd., Wales, UK (PCM, JG, TW)
AD  - Department of Public Health, University of Adelaide, South Australia, Australia 
      (JG).
FAU - Evans, Marc
AU  - Evans M
AD  - University Health Board, Llandough, Wales, UK (ME)
FAU - Ward, Thomas
AU  - Ward T
AD  - Health Economics & Outcomes Research Ltd., Wales, UK (PCM, JG, TW)
FAU - Bennett, Hayley
AU  - Bennett H
AD  - Swansea Centre for Health Economics, Swansea University, Wales, UK (PCM, HB)
FAU - Bergenheim, Klas
AU  - Bergenheim K
AD  - Global Health Economics & Outcomes Research, AstraZeneca, Molndal, Sweden (KB)
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150116
PL  - United States
TA  - Med Decis Making
JT  - Medical decision making : an international journal of the Society for Medical 
      Decision Making
JID - 8109073
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Insulin)
RN  - 0 (hemoglobin A1c protein, human)
RN  - 9100L32L2N (Metformin)
SB  - IM
MH  - Cost-Benefit Analysis
MH  - *Decision Making
MH  - *Diabetes Mellitus, Type 2/blood/drug therapy/economics
MH  - Glycated Hemoglobin/analysis/economics
MH  - *Guidelines as Topic
MH  - Health Care Costs
MH  - Humans
MH  - Insulin/administration & dosage/economics
MH  - Metformin/administration & dosage/economics
MH  - *Models, Economic
MH  - United Kingdom
OTO - NOTNLM
OT  - cost-effectiveness analysis.
OT  - decision aids
OT  - internal medicine
OT  - provider decision making
EDAT- 2015/01/18 06:00
MHDA- 2016/03/17 06:00
CRDT- 2015/01/18 06:00
PHST- 2014/01/13 00:00 [received]
PHST- 2014/11/23 00:00 [accepted]
PHST- 2015/01/18 06:00 [entrez]
PHST- 2015/01/18 06:00 [pubmed]
PHST- 2016/03/17 06:00 [medline]
AID - 0272989X14565821 [pii]
AID - 10.1177/0272989X14565821 [doi]
PST - ppublish
SO  - Med Decis Making. 2015 Jul;35(5):660-70. doi: 10.1177/0272989X14565821. Epub 2015 
      Jan 16.