Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA1c , weight and hypoglycaemic event incidence.

Abstract

AIMS:

Insulin therapy is indicated for people with Type 1 diabetes mellitus; however, treatment-related weight gain and hypoglycaemia represent barriers to optimal glycaemic management. This study assessed the health economic value of maintained reductions in HbA1c , BMI and hypoglycaemia incidence among the UK Type 1 diabetes population.

METHODS:

The Cardiff Type 1 Diabetes Model was used to estimate lifetime costs, life-years and quality-adjusted life-years (QALYs) for individuals with Type 1 diabetes at different baseline HbA1c , BMI and hypoglycaemic event rates. Results were discounted at 3.5%, and the net monetary benefit associated with improving Type 1 diabetes management was derived at £20 000/QALY gained. Per-person outputs were inflated to national levels using UK Type 1 diabetes prevalence estimates.

RESULTS:

Modelled subjects with an HbA1c of 86 mmol/mol (10.0%) were associated with discounted lifetime per-person costs of £23 795; £12 649 of which may be avoided by maintaining an HbA1c of 42 mmol/mol (6.0%). Combined with estimated QALY gains of 2.80, an HbA1c of 42 mmol/mol (6.0%) vs. 86 mmol/mol (10.0%) was associated with a £68 621 per-person net monetary benefit. Over 1 year, unit reductions in BMI produced £120 per-person net monetary benefit, and up to £197 for the avoidance of one non-severe hypoglyceamic event.

CONCLUSIONS:

Maintained reductions in HbA1c significantly alleviate the burden associated with Type 1 diabetes in the UK. Given the influence of weight and hypoglycaemia on health economic outcomes, they must also be key considerations when assessing the value of Type 1 diabetes technologies in clinical practice.

• Authors: P McEwan, H Bennett, K Bolin, M Evans, K Bergenheim
• Journal: Diabetic medicine : a journal of the British Diabetic Association (Diabet Med) Vol. 35 Issue 5 Pg. 557-566 (05 2018) ISSN: 1464-5491 [Electronic] England
• PMID: 29377320 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

Chemical References

• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin
• hemoglobin A1c protein, human

Topics

• Adult
• Body Mass Index
• Cost-Benefit Analysis
• Diabetes Mellitus, Type 1 (drug therapy, economics)
• Disease Management
• Female
• Glycated Hemoglobin (metabolism)
• Health Care Costs
• Humans
• Hypoglycemia (chemically induced, economics, epidemiology)
• Hypoglycemic Agents (economics, therapeutic use)
• Insulin (economics, therapeutic use)
• Male
• Quality-Adjusted Life Years
• United Kingdom
• Weight Gain