Asseburg, C

He, J

Ingham, M

Neslusan, C

Willis, M

Elsevier - Publisher Connector 

Abstracts A59
PDB24
COST-EFFECTIVENESS OF ROUX-EN-Y GASTRIC BYPASS IN TYPE 2 
DIABETES PATIONTS IN CANADA
Hashemi L, Minshall ME
Covidien, North Haven, CT, USA
OBJECTIVES: Our objective was to estimate the cost-effectiveness of Roux-en-Y 
Gastric Bypass (RYGB) for treating obese patients with type 2 diabetes mellitus 
(T2DM) in Canada compared with standard medical management using clinical data 
from a prospective observational study conducted at an academic medical center in 
the United States. METHODS: Our study used the CORE Diabetes Model which 
employs Monte Carlo simulation with tracker variables to estimate the lifetime costs 
and clinical outcomes of RYGB as a treatment for obese patients with T2DM com-
pared with standard medical management. Costs ($CAN 2009) and clinical outcomes 
were discounted at 5% consistent with Canadian-speciﬁc guidelines. RESULTS: The 
base-case analysis showed that RYGB improved life-expectancy and quality-adjusted 
life years (QALYs) compared with medical management of obese patients with T2DM 
at a lower cost and was therefore cost-saving in the base case. The incremental mean 
discounted life expectancy for RYGB was increased by 0.44 years while QALYs 
increased by 0.54 years. We doubled the price of RYGB in Canada (from $CAN 6,837 
to $CAN 13,674) while holding everything else constant and found that RYGB moved 
to an incremental cost-effectiveness ratio of $CAN 7,946 placing it well below the 
threshold value proposed by Laupacis et al in 1992 of $CAN 20,000 for a cost-
effective intervention worth adopting. CONCLUSIONS: The results of our study 
suggest that RYGB is cost saving in Canada compared with standard medical manage-
ment of obese patients with T2DM. Our results were robust to doubling the price of 
RYGB compared with medical management of T2DM in Canada.
PDB25
THE ECONOMIC IMPACT OF WEIGHT LOSS FOR PATIENTS WITH 
NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS (T2DM) IN THE US
Willis M1, Asseburg C2, Neslusan C3, He J3, Ingham M3
1IHE, Lund, Sweden, 2ESiOR, Kuopio, Finland, 3Johnson and Johnson Pharmaceutical Services 
L.L.C., Raritan, NJ, USA
OBJECTIVES: As excess weight adversely affects health outcomes in patients with 
T2DM, weight loss a fundamental goal of treatment. This study assessed the effect of 
weight reduction on long-term health outcomes and associated direct medical care 
costs for patients newly diagnosed with T2DM. METHODS: We simulated 500 
cohorts of 1000 patients over 25 years using the Economic and Health Outcomes 
(ECHO)-T2DM model, which captures the development of key micro- and macrovas-
cular diabetic complications. All patients were assumed to increase weight over time 
(0.51 pounds per year), however, half of the patients were assumed to lose 10 pounds 
in the ﬁrst year, so that a 10 pound differential was maintained. Pharmacotherapy 
was administered according to the 2009 American Diabetes Association Consensus 
Statement. The effect of weight on T2DM complications was modeled using risk 
equations from the UK Prospective Diabetes Study, wherein weight is a direct deter-
minant of the risk only of congestive heart failure (CHF). The risks of stroke and 
myocardial infarction are affected only indirectly via the linkage with CHF and mor-
tality risk is only affected indirectly via macrovascular event history. We assumed that 
weight change directly affects QALYs, utilizing T2DM-speciﬁc utility parameters from 
the CODE-2 study. Costs and health outcomes were discounted at 3%. RESULTS: 
Ten pounds of weight loss resulted in cost-savings of $613 over an average of 14.6 
years, mainly attributable to reductions in CHF incidence. Life years increased margin-
ally; QALYs, however, increased more substantially (0.16). CONCLUSIONS: At a 
willingness-to-pay threshold of $50,000, an intervention would be welfare improving 
at an incremental cost of up to $8,613 over 14.6 years. As this modeling exercise 
conservatively excluded a number of beneﬁts of weight loss (e.g., effects via improved 
lipids and blood pressure and reductions in cancer and other obesity-related illnesses), 
the true economic value is likely greater.
PDB26
MODELLING COST EFFECTIVENESS OF BEHAVIOUR MODIFICATION 
PROGRAMMES AND EFFECTS ON MEDICATION: CASE STUDY OF 
EDUCATION PROGRAMMES IN DIABETES
Brennan A, Gillett M
University of Shefﬁeld, SHEFFIELD, UK
OBJECTIVES: 1) To model long-term clinical and cost-effectiveness of the Diabetes 
Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) 
for people with newly diagnosed Type 2 diabetes, versus usual care in the UK; 2) To 
consider issues arising in modelling education / behaviour modiﬁcation programmes 
and how such modelling can support the development of clinical research. METHODS: 
The modelling undertakes a long-term cost-utility analysis with evidence from a 
12-month multicentre cluster RCT using the Shefﬁeld Type 2 Diabetes Model. Short 
and long-term outcomes include Hba1c, lipids and systolic blood pressure, patients’ 
weight and smoking status. The model examines long-term use of therapies including 
oral hypoglycemic agents. Risk / disease progression models based on UKPDS and 
other evidence are used to estimate incidence of complications, mortality, costs and 
health-related quality of life. RESULTS: Estimated mean (95% CI) incremental life-
time costs per person (trial based) = ≤ 218 (-≤ 194 to ≤ 758), incremental QALYs = 
0.0406 (-0.0283 to 0.1050), and incremental cost/QALY = ≤ 5369. Using current 
real-world costs, the incremental cost = ≤ 91 (-≤ 321 to ≤ 631) and incremental cost/
QALY = ≤2241. Probabilistic sensitivity analysis suggests an 87% likelihood of being 
cost effective at a ≤20,000/QALY threshold. One-way sensitivity analysis showed 
results are most affected by effects around weight and smoking, and that DESMOND 
would likely be cost effective under the conservative assumption of zero effect main-
tained after year one. CONCLUSIONS: Whilst results suggest that DESMOND is cost 
effective compared to usual care, further modelling should include: whether mainte-
nance of effect via longer-term top-up education is effective, subgroup analysis of those 
who respond / do not respond, direct modelling of exercise beneﬁts, and adaptation 
to education programmes such as Dose Adjustment for Normal Eating (DAFNE) in 
Type 1 diabetes.
PDB27
COST AND EFFECTIVENESS OF EDUCATIONAL STRATEGIES FOR THE 
CONTROL AND TREATMENT OF TYPE 2 DIABETES (DMT2) AND 
CARDIOVASCULAR RISK FACTORS (CVRF)
Caporale JE, Pﬁrter G, Elgart J, Gonzalez L, Rucci E, Lapertosa S, Villagra M, 
Gagliardino JJ
National University of La Plata, La Plata, Buenos Aires, Argentina
OBJECTIVES: To estimate and compare costs and effectiveness of different educa-
tional interventions at PRODIACOR study. METHODS: PRODIACOR is a prospec-
tive study (three years), randomized controlled trial, which aims to improve the quality 
of care for people with type 2 diabetes, optimizing the use of resources and prevent 
complications, thus reducing morbidity and socioeconomic cost. Includes 4 groups 
(control, educated patients, doctors educated and educated patients and physicians) 
of 9 physicians and 117 patients each. Clinical and metabolic changes were recorded 
in an ad-hoc form (annually and semiannually). Costs and utilization rates for drugs, 
consultations and practices were obtained from the administrative dataset of the cover-
age institutions involved. The intervention was approved by independent ethics com-
mittee. We performed a descriptive and inferential statistical analysis, verifying 
differences in means and proportions using t test, ANOVA and Chi square. RESULTS: 
Clinical and metabolic: although there was improvement of several registered indica-
tors no signiﬁcant differences in the percentage of patients at goal between groups 
were found. Cost: in the period before the intervention the total average expenditure 
for each patient was AR$ 1,848 (66% drugs, 26% practices and 8% consultations). 
No signiﬁcant differences between all the intervention groups were found. After the 
ﬁrst year all groups signiﬁcantly increased total average expenditure (Group 1: 259%; 
Group 2: 39%, Group 3: 59%, Group 4: 61%). The costs then progressively decreased 
in all groups and at the third year the total average expenditure was AR $1551 (72% 
drug, 26% practices and 2% consultations). Group 3 had the lowest average total 
expenditure (AR$ 925), followed by Group 4 (AR$ 1264), Group 1 (AR$ 1881) and 
Group 2 (AR$ 2133). CONCLUSIONS: Although preliminary, these results suggest 
that educational interventions improve clinical indicators and reduce direct medical 
costs associated with diabetes with a satisfactory cost-effectiveness.
PDB28
COST-EFFECTIVENESS OF SOMASTATIN ANALOGUES FOR THE 
TREATMENT OF ACROMEGALY IN COLOMBIA
Alfonso R1, Izquierdo C2, Diaz-Sotelo OD2, Maestre K3, Zarate JP3
1University of Washington, Seattle, WA, USA, 2RANDOM Foundation, Bogota, DC, 
Colombia, 3Novartis A.G., Bogotá, DC, Colombia
OBJECTIVES: To evaluate the cost-effectiveness of somatostatin analogues in the 
treatment of acromegaly in Colombia. METHODS: Cost-effectiveness of both soma-
tostatin analogues, octreotide and lanreotide, was estimated using decision analysis. 
Response to treatment in the model was derived from a recent meta-analysis. Costs 
and resource utilization included only data directly related to the treatment of the 
acromegaly during the 2 year time-horizon in Colombia. Transition probabilities were 
calculated based on the efﬁcacy results from clinical trials pooled in the meta-analysis. 
The model’s effectiveness outcome is patients who are successfully controlled in terms 
of their Growth Hormone <2.5 mcg. RESULTS: Using the estimated prevalence of the 
disease in Colombia, a hypothetical cohort of 2,503 subjects with acromegaly with 
an average age of 50 years was included in the model. The total annual medical treat-
ment costs for the octreotide group were COP$ 162,802 million, compared to the 
total annual costs for the lanreotide group of COP$ 214,047 million. In the octreotide 
arm 65.3% of the patients and in the lanreotide arm 59.5% of the patients were 
successfully controlled. The estimated number of deaths was 164 and 168 for the 
groups with octreotide and lanreotide, respectively. Because the costs are lower and 
the effectiveness is higher for octreotide in comparison with lanreotide, octreotide is 
more cost-effective (dominant). Probabilistic sensitivity analyses were consistent 
showing octreotide as the most cost-effective option. . CONCLUSIONS: Costs and 
effects of octreotide compare favorably to those of lanreotide in the treatment of 
acromegaly in Colombia. Sensitivity analysis showed that despite the uncertainty in 
cost-effectiveness ratio this result is robust.
PDB29
COST/EFFECTIVENESS STUDY OF THIAZOLIDINEDIONES IN DIABETIC 
MEDICATION∼A TAIWANESE EMPIRICAL STUDY
Huang WF1, Tsai YW1, Hsiao FY2, Hsieh CF1, Yang CL1
1Institute of Health & Welfare Policy, National Yang-Ming University, Taipei, Taiwan, 
2University of Maryland School of Pharmacy, Baltimore, MD, USA
OBJECTIVES: Using Taiwan’s National Health Insurance (NHI) claims data, we took 
thiazolidinediones (TZDs) as study target to explore its impact on medical expenditure 
and prognosis of diabetic patients. METHODS: This is a population-based retrospec-
tive cohort study on diabetic patients during 2000∼2006. Our study population was 
those who had a diagnosis of diabetes and took oral hypoglycemic agents. We classi-


PDB25 THE ECONOMIC IMPACT OF WEIGHT LOSS FOR PATIENTS WITH NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS (T2DM) IN THE US 

file:///data/remote/core/dit/data/elsevier/pdf/a70/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMTA5ODMwMTUxMDcyMjcyNQ==.pdf

PDB25 THE ECONOMIC IMPACT OF WEIGHT LOSS FOR PATIENTS WITH NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS (T2DM) IN THE US

Abstract

Similar works

Full text

Available Versions

Elsevier - Publisher Connector

Elsevier - Publisher Connector