26 research outputs found
Cost-effectiveness of Implementing the Interventions for Diabetes Prevention and Control in the Community and Military Settings
Diabetes is an increasingly prevalent and costly cause of morbidity and mortality, representing not only a major clinical care concern but an immense public health challenge. In 2010, diabetes affected 25.8 million Americans â 8.3% of the US population and 26.9% of those aged 65 years or older. People with diabetes are disproportionately affected by eye and renal disease, non-traumatic amputations, and cardiovascular disease, which result in significant health-care costs of 42,179-42,051-17,186 and 7,777-18,263-$29,331 per QALY gained. Generally, these results were robust in sensitivity analyses. This dissertation provided supporting evidence that compared with usual care or PROV, the CCM for secondary and tertiary diabetes prevention in the community and military settings as well as the ODPP for primary diabetes prevention in the primary care setting appear to be economically reasonable interventions for diabetes management. These findings are of public health significance as the economic evaluation conducted in this dissertation is an important component of evidence-based clinical and public health practices, which is a decision making aid to help assess the relative value of alternative interventions that can enhance clinical care and public health
Cost- effectiveness of long- acting insulin analogues vs intermediate/long- acting human insulin for type 1 diabetes: A population- based cohort followed over 10 years
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154921/1/bcp14188.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154921/2/bcp14188_am.pd
Comparative cardiovascular safety of GLP-1 receptor agonists versus other glucose-lowering agents in real-world patients with type 2 diabetes: a nationwide population-based cohort study
Abstract
Background
Current evidence about the cardiovascular safety of glucagon-like peptide-1 receptor agonist (GLP-1ra) possesses limited generalizability to real-world patients with type 2 diabetes (T2D) in usual practice. This study aimed to investigate the comparative cardiovascular safety of GLP-1ra in comparisons with dipeptidyl peptidase-4 inhibitor (DPP-4i), sulfonylurea (SU), and insulin in a real-world population with T2D.
Methods
Adults with newly-diagnosed T2D were identified from Taiwanâs National Health Insurance Research Database in 2003â2014. A prevalent new-user cohort design was adopted to include a broad representation of real-world T2D patients being treated with GLP-1ra. The between-group comparability of baseline patient characteristics was achieved by matching on (1) initiation time of study drugs, (2) prior exposure to glucose-lowering agents, and (3) diabetes severity and complications, comorbidities, and concomitant cardiovascular medications using propensity scores. The primary outcome was a composite of cardiovascular disease (CVD) events and assessed up to the end of 2015. Cox modeling was employed to assess the association between study drugs and outcomes.
Results
A total of 3195 GLP-1ra stable users was identified in 2011-2014. 1893, 1829, and 1367 GLP-1ra stable users were 1:1 matched to DPP-4i, SU and insulin users, respectively. Compared to DPP-4i, SU and insulin, the use of GLP-1ra was associated with a lower risk of composite CVD events [hazard ratio (95% confidence interval) 0.73 (0.57â0.96), 0.76 (0.57â1.00), and 0.81 (0.62â1.07), respectively]. Subgroup analyses revealed that GLP-1ra versus DPP-4i yielded a greater cardiovascular benefit in those without established CVD versus those with established CVD.
Conclusions
This comparison study extends the supporting evidence for the cardiovascular safety of GLP-1ra to a broad spectrum of real-world T2D patients using GLP-1ra.http://deepblue.lib.umich.edu/bitstream/2027.42/173662/1/12933_2020_Article_1053.pd
Cost-effectiveness of sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors among patients with type 2 diabetes with and without established cardiovascular diseases: A model-based simulation analysis using 10-year real-world data and targeted literature review
AimWe conducted a model-based economic analysis of sodium-glucose cotransporter-2 inhibitors (SGLT2is) versus dipeptidyl peptidase-4 inhibitors (DPP4is) in patients with type 2 diabetes (T2D), with and without established cardiovascular diseases (CVDs), using 10-year real-world data.Materials and MethodsA Markov model was utilized to estimate healthcare costs and quality-adjusted life-years (QALYs) over a 10-year simulation time horizon from a healthcare sector perspective, with both costs and QALYs discounted at 3% annually. Model inputs were derived from analyses of Taiwanâs National Health Insurance Research Database or published studies of Taiwanese populations. The primary outcome measure was the incremental cost-effectiveness ratios (ICERs). Incorporated with our study findings, a targeted literature review was conducted to synthesize updated evidence on the cost-effectiveness of SGLT2is versus DPP4is.ResultsOver 10âyears, use of SGLT2is versus DPP4is yielded ICERs of 4186 per QALY gained for patients with T2D, with and without established CVDs, respectively. Results were robust across a series of sensitivity and scenario analyses, showing ICERs between 8467 per QALY gained for patients with T2D with established CVDs and between 37â122 per QALY gained for patients with T2D without established CVDs.ConclusionsUse of SGLT2is versus DPP4is was highly cost-effective for patients with T2D regardless of their CVD history in real-world clinical practice. Our results extend current evidence by showing SGLT2is as an economically rational alternative over DPP4is for T2D treatment in routine care. Future research is warranted to explore the heterogeneous economic benefits of SGLT2is given diverse patient characteristics in clinical settings.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172989/1/dom14708.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172989/2/dom14708_am.pd
Cost-effectiveness of GLP-1 receptor agonists versus insulin for the treatment of type 2 diabetes: a real-world study and systematic review
Abstract
Background
To conduct a real-word-study-based cost-effectiveness analysis of a GLP-1 receptor agonist (GLP-1RA) versus insulin among type 2 diabetes patients requiring intensified injection therapy and a systematic review of cost-effectiveness studies of GLP-1RAs versus insulin.
Methods
Individual-level analyses incorporating real-world effectiveness and cost data were conducted for a cohort of 1022 propensity-score-matched pairs of GLP-1RA and insulin users from Taiwanâs National Health Insurance Research Database, 2007â2016. Study outcomes included the number needed to treat (NNT) to prevent one case of clinical events, healthcare costs, and cost per case of event prevented. Costs were in 2019 US dollars. Analyses were performed from a third-party payer and healthcare sector perspectives. Structured systematic review procedures were conducted to synthesize updated evidence on the cost-effectiveness of GLP-1RAs versus insulin.
Results
Over a mean follow-up of 2.3Â years, the NNT using a GLP-1RA versus insulin to prevent one case of all-cause mortality and hospitalized hypoglycemia was 57 and 30, respectively. Using GLP-1RAs instead of insulin cost US29,115 per case of all-cause mortality and hospitalized hypoglycemia prevented, respectively, from the payer perspective, and saved US10,293, respectively, from the healthcare sector perspective. Sensitivity analyses showed that the probability of using GLP-1RAs versus insulin being cost-effective for preventing one case of all-cause mortality or hospitalized hypoglycemia ranged from 60 to 100%. The systematic review revealed a cost-effective profile of using GLP-1RAs versus insulin.
Conclusions
Using GLP-1RAs versus insulin for type 2 diabetes patients requiring intensified injection therapy in clinical practice is cost-effective.http://deepblue.lib.umich.edu/bitstream/2027.42/173665/1/12933_2020_Article_1211.pd
Costâeffectiveness of longâacting insulin analogues vs
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154921/1/bcp14188.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154921/2/bcp14188_am.pd
Comparative predictive ability of visit-to-visit HbA1c variability measures for microvascular disease risk in type 2 diabetes
Abstract
Background
To assess the associations of various HbA1c measures, including a single baseline HbA1c value, overall mean, yearly updated means, standard deviation (HbA1c-SD), coefficient of variation (HbA1c-CV), and HbA1c variability score (HVS), with microvascular disease (MVD) risk in patients with type 2 diabetes.
Methods
Linked data between National Cheng Kung University Hospital and Taiwanâs National Health Insurance Research Database were utilized to identify the study cohort. The primary outcome was the composite MVD events (retinopathy, nephropathy, or neuropathy) occurring during the study follow-up. Cox model analyses were performed to assess the associations between HbA1c measures and MVD risk, with adjustment for patientsâ baseline HbA1c, demographics, comorbidities/complications, and treatments.
Results
In the models without adjustment for baseline HbA1c, all HbA1c variability and mean measures were significantly associated with MVD risk, except HVS. With adjustment for baseline HbA1c, HbA1c-CV had the strongest association with MVD risk. For every unit of increase in HbA1c-CV, the MVD risk significantly increased by 3.42- and 2.81-fold based on the models without and with adjustment for baseline HbA1c, respectively. The associations of HbA1c variability and mean measures with MVD risk in patients with baseline HbA1câ<â7.5% (58Â mmol/mol) were stronger compared with those in patients with baseline HbA1cââ„â7.5% (58Â mmol/mol).
Conclusions
HbA1c variability, especially HbA1c-CV, can supplement conventional baseline HbA1c measure for explaining MVD risk. HbA1c variability may play a greater role in MVD outcomes among patients with relatively optimal baseline glycemic control compared to those with relatively poor baseline glycemic control.http://deepblue.lib.umich.edu/bitstream/2027.42/173663/1/12933_2020_Article_1082.pd
Association of Renal and Cardiovascular Safety With DPP- 4 Inhibitors vs. Sulfonylureas in Patients With Type 2 Diabetes and Advanced Chronic Kidney Disease
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168511/1/cpt2262-sup-0001-FigS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168511/2/cpt2262_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168511/3/cpt2262-sup-0002-FigS2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168511/4/cpt2262.pd
Chronic kidney outcomes associated with GLP-1 receptor agonists versus long-acting insulins among type 2 diabetes patients requiring intensive glycemic control: a nationwide cohort study
Abstract Background Effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus long-acting insulins (LAIs) on preventing progressive chronic kidney outcomes is uncertain for type 2 diabetes (T2D) patients requiring intensive glycemic control. This study aimed to evaluate comparative effectiveness of GLP-1RA versus LAI therapies on progressive chronic kidney outcomes among patients having poor glycemic control and requiring these injectable glucose-lowering agents (GLAs). Methods 7279 propensity-score-matched pairs of newly stable GLP-1RA and LAI users in 2013â2018 were identified from Taiwanâs National Health Insurance Research Database and followed until death or 12/31/2019 (intention-to-treat). Subdistributional hazard model was utilized to assess the comparative effectiveness on a composite renal outcome (i.e., renal insufficiency [eGFRâ<â15Â mL/min/1.73 m2], dialysis-dependent end-stage renal disease [ESRD], or renal death) and its individual components. Sensitivity analyses with the as-treated scenario, PS weighting, high-dimensional PS techniques, using cardiovascular diseases (CVDs) as positive control outcomes, and interaction testing were performed. Results In primary analyses, subdistribution hazard ratios (95% CIs) for initiating GLP-1RAs versus LAIs for the composite renal outcome, renal insufficiency, dialysis-dependent ESRD, and renal death were 0.39 (0.30â0.51), 0.43 (0.32â0.57), 0.29 (0.20â0.43), and 0.28 (0.15â0.51), respectively. Sensitivity analysis results were consistent with the primary findings. CVD history and the medication possession ratio of prior oral GLAs possessed modification effects on GLP-1RA-associated kidney outcomes. Conclusion Using GLP-1RAs versus LAIs was associated with kidney benefits in T2D patients requiring intensive glycemic control and potentially at high risk of kidney progression. GLP-1RAs should be prioritized to patients with CVDs or adherence to prior oral GLAs to maximize kidney benefits