A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68)

Abstract

Aims/hypothesis. The aim of this study was to develop a simulation model for Type 2 diabetes that can be used to estimate the likely occurrence of major diabetes-related complications over a lifetime, in order to calculate health economic outcomes such as qualityadjusted life expectancy. Methods. Equations for forecasting the occurrence of seven diabetes-related complications and death were estimated using data on 3642 patients from the United Kingdom Prospective Diabetes Study (UKPDS). After examining the internal validity, the UKPDS Outcomes Model was used to simulate the mean difference in expected quality-adjusted life years between the UKPDS regimens of intensive and conventional blood glucose control. Results. The model's forecasts fell within the 95% confidence interval for the occurrence of observed events during the UKPDS follow-up period. When the model was used to simulate event history over patients' lifetimes, those treated with a regimen of conventional glucose control could expect 16.35 undiscounted quality-adjusted life years, and those receiving treatment with intensive glucose control could expect 16.62 quality-adjusted life years, a difference of 0.27 (95% CI: −0.48 to 1.03). Conclusions/interpretations. The UKPDS OutcomesModel is able to simulate event histories that closely match observed outcomes in the UKPDS and that can be extrapolated over patients' lifetimes. Its validity in estimating outcomes in other groups of patients, however, remains to be evaluated. The model allows simulation of a range of long-term outcomes, which should assist in informing future economic evaluations of interventions in Type 2 diabetes. The centres of the UKPDS are listed at the end of the paper Conflict of interest. Several authors (as indicated above) are employed by the University of Oxford. This paper describes and places in the public domain a simulation model that we have called the UKPDS Outcomes Model. All of the information necessary to reproduce the UKPDS Outcomes Model is provided in this article, but it is conceivable that a future user with a commercial interest in the UKPDS Outcomes Model might prefer to use the software already created by University programmers. Depending on the nature of the proposed use of the UKPDS Outcomes Model, the University of Oxford might charge a fee in this case.

Metabolic effects of interventions to increase exercise in adults with type 2 diabetes

“…It is possible that, compared with men, women do not achieve similar exercise intensities, decrease spontaneous activity to a greater extent when enrolled in exercise studies [39], experience smaller increases in resting metabolic rate, or experience smaller fitness gains [37,39,40]. Differences between the sexes in diabetes disease characteristics have been reported but are not well understood [41][42][43][44][45][46]. Future primary studies should examine differences between men and women within studies to provide more information on this issue.…”

Cost-effectiveness of primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes: results from the Collaborative Atorvastatin Diabetes Study (CARDS)

“…That is, differences in life expectancy may be attributed to atorvastatin, as this treatment is also associated with lower rates of nonfatal CVD events, which are expected to lead to lower subsequent mortality. The impact of non-fatal events on subsequent mortality was recognised by the United Kingdom Prospective Diabetes Study (UKPDS) investigators and was modelled explicitly in their extrapolation of the UKPDS trial results over a patient's lifetime [14]. In the sensitivity analysis in this study, a further supplementary assumption was made, namely that non-fatal CVD events were associated with an increase in the annual probability of mortality in the same manner and using the same calculations adopted by the UKPDS investigators [14].…”

“…The impact of non-fatal events on subsequent mortality was recognised by the United Kingdom Prospective Diabetes Study (UKPDS) investigators and was modelled explicitly in their extrapolation of the UKPDS trial results over a patient's lifetime [14]. In the sensitivity analysis in this study, a further supplementary assumption was made, namely that non-fatal CVD events were associated with an increase in the annual probability of mortality in the same manner and using the same calculations adopted by the UKPDS investigators [14]. To undertake this part of the analysis, it was necessary to extrapolate non-fatal CVD event rates beyond the trial end.…”

Intensified glucose lowering in type 2 diabetes: time for a reappraisal

“…This point is often emphasised in current guidelines, but the practical implications have not been explored in any detail. Recent studies, which have used modelling techniques to estimate the impact of glycaemic control on life expectancy, are enlightening in this respect [33,34]. The UKPDS outcomes model estimated that intensified glucose control would increase quality-adjusted life years (QALY) by 0.27, or about 99 days [33].…”

“…Recent studies, which have used modelling techniques to estimate the impact of glycaemic control on life expectancy, are enlightening in this respect [33,34]. The UKPDS outcomes model estimated that intensified glucose control would increase quality-adjusted life years (QALY) by 0.27, or about 99 days [33]. Huang et al [35] estimated that intensive control would add 106 days of life expectancy to an otherwise healthy newly diagnosed diabetic patient aged 60-64 years, decreasing with increasing comorbidities, longer duration of disease, or advancing age to only five to eight additional days.…”