The cost-effectiveness of interventions in diabetes: A review of published economic evaluations in the UK setting, with an eye on the future
Tucker, DMD and Palmer, AJ, The cost-effectiveness of interventions in diabetes: A review of published economic evaluations in the UK setting, with an eye on the future, Primary Care Diabetes, 5, (1) pp. 9-17. (2011) [Substantial Review]
Aim: To synthesise key outcomes data from cost-effectiveness studies in diabetes, in the UK
setting, and describe a narrative for the evidence-base, in order to understand the direction
that future health economics research in this field could be heading.
Methods: The peer-reviewed literature was searched at http://www.pubmed.com for health
economics analyses in diabetes in theUKsetting published between 1995 and 2008, using the
keywords: "costs", "cost-effectiveness", "diabetes", "UK". Studies on screening for diabetes
or prevention of diabetes were excluded, along with studies that looked purely at cost of
diabetes treatment or monitoring.
Results: There were over 350 hits on MEDLINE. A total of 23 articles were identified and
reviewed. 18 studies were in type 2, two in type 1 and three studies in both types 1 and type
2 diabetes. All studies evaluated treatment from the perspective of the NHS, with the time
horizons varying from 12 months to patient lifetimes. 13 studies estimated quality-adjusted
life expectancy (QALE). The majority of studies used health economics modelling techniques
to project clinical benefit and cost outcomes beyond the context of clinical trials, with
Markov-type models predominating. The United Kingdom Prospective Study of Diabetes
was the most frequently cited source of clinical effectiveness and cost data. Most studies
were funded by the pharmaceutical industry and evaluated more expensive products, rather
than cheaper generic therapies such as human insulin and metformin monotherapy.
Conclusion: Treatment-to-target in patients with diabetes in the UK is generally cost-effective
and sometimes cost-saving vs. standard care. Ongoing health economics analysis in diabetes
is essential as new clinical data are published. Future analysis of clinical and cost outcomes
in diabetes could be expected to look beyond the impact of interventions on HbA1c in isolation,
as manufacturers seek to differentiate innovative products in the market. Furthermore,
it is anticipated that the competitiveness in the market for interventions in diabetes will
lead to future cost-effectiveness analysis taking more interest in comparisons of off-patent
medication and generic, fixed-dose combination therapies.
Diabetes; Review; Costs; Economics; Cost-effectiveness; Modelling; UK