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Cost-utility analysis in a UK setting of self-monitoring of blood glucose in patients with type 2 diabetes

Citation

Palmer, AJ and Dinneen, S and Gavin, JR and Gray, A and Herman, WH and Karter, AJ, Cost-utility analysis in a UK setting of self-monitoring of blood glucose in patients with type 2 diabetes, Current Medical Research and Opinion, 22, (5) pp. 861-872. ISSN 0300-7995 (2006) [Refereed Article]

DOI: doi:10.1185/030079906X104669

Abstract

Background: Self-monitoring of blood glucose (SMBG) in type 2 diabetes patients has been shown in meta-analyses of randomized trials to improve HbA1c by ∼0.4% when compared to no SMBG. However, the cost of testing supplies is high, improvements in health utility due to improved glycaemic control may be possible and cost-effectiveness has not been evaluated. Methods: A peer-reviewed validated model projected improvements in lifetime quality-adjusted life years (QALYs), long-term costs and cost-effectiveness of SMBG versus no SMBG. Markov/Monte Carlo modelling simulated the progression of complications (cardiovascular, neuropathy, renal and eye disease). Transition probabilities and HbA1c-dependent adjustments came from the United Kingdom Prospective Diabetes Study (UKPDS) and other major studies. Effects of SMBG on HbA1c. came from clinical studies, meta-analyses and population studies, but can only be considered 'moderate' levels of evidence. Costs of complications were retrieved from published sources. Direct costs of diabetes complications and SMBG were projected over patient lifetimes from a UK National Health Service perspective. Outcomes were discounted at 3.5% annually. Extensive sensitivity analyses were performed. Results: Depending on the type of diabetes treatment (diet and exercise/oral medications/insulin), improvements in glycaemic control with SMBG improved discounted QALYs anywhere from 0.165 to 0.255 years, with increased total costs of £1013-£2564/patient, giving incremental cost-effectiveness ratios of £4508:£15515/QALY gained, well within current UK willingness-to-pay limits. Results were robust under a wide range of plausible assumptions. Conclusions: Based on the moderate level of clinical evidence available to date, improvements in glycaemic control with interventions, including SMBG, can improve patient outcomes, with acceptable cost-effectiveness ratios in the UK setting. © 2006 Librapharm Limited.

Item Details

Item Type:Refereed Article
Research Division:Economics
Research Group:Applied Economics
Research Field:Health Economics
Objective Division:Health
Objective Group:Health and Support Services
Objective Field:Health Policy Economic Outcomes
Author:Palmer, AJ (Professor Andrew Palmer)
ID Code:74667
Year Published:2006
Web of Science® Times Cited:30
Deposited By:Research Division
Deposited On:2011-12-09
Last Modified:2011-12-13
Downloads:0

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