Economic evaluation of therapeutic interventions to prevent Type 2 diabetes in Canada

被引:42
作者
Caro, JJ
Getsios, D
Caro, I
Klittich, WS
O'Brien, JA
机构
[1] Caro Res, Concord, MA 01742 USA
[2] McGill Univ, Royal Victoria Hosp, Div Gen Internal Med, Montreal, PQ H3A 1A1, Canada
[3] Caro Res, Hammonds Plains, NS, Canada
[4] Caro Res, Dorval, PQ, Canada
关键词
Canada; costs; diabetes; impaired glucose tolerance;
D O I
10.1111/j.1464-5491.2004.01330.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims To compare the health and economic outcomes of using acarbose, an intensive lifestyle modification programme, metformin or no intervention to prevent progression to diabetes in Canadian individuals with impaired glucose tolerance (IGT). Methods A model was developed to simulate the course of individuals with IGT under each treatment strategy. Patients remain in the IGT state or transition from IGT to diabetes, to normal glucose tolerance (NGT) or to death. Effectiveness and resource use data were derived from published intervention trials. A comprehensive health-care payer perspective incorporating all major direct costs, reported in 2000 Canadian dollars, was adopted. Results Over a decade, 70 of the 1000 untreated patients are expected to die and 542 develop diabetes. Intensive lifestyle modification is estimated to prevent 117 cases of diabetes, while metformin would prevent 52 and acarbose 74 cases. The proportion of those who return to NGT also increases with any treatment. While lifestyle modification is more effective, it can increase overall costs depending on how it is implemented, whereas acarbose and metformin reduce costs by nearly $1000 per patient. Lifestyle modification was cost effective, varying from $749/life year gained (LYG) vs. no treatment to about $10 000/LYG vs. acarbose. Acarbose costs somewhat more than metformin, but is more effective: $1798/LYG. Conclusion The results of this model suggest that the treatment of IGT in Canada is a cost-effective way to prevent diabetes and may generate savings. While pharmacological treatments tended to be less costly, intensive lifestyle modification, if maintained, led to the greatest health benefits at reasonable incremental costs.
引用
收藏
页码:1229 / 1236
页数:8
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