Economic Evaluation Of Four Schemes For Screening And Diagnosis Of Type 2 Diabetes In Adults In Colombia

Abstract

Objectives: To estimate the clinical and economic trade-offs involved in using the molecular assay EPICUP to aid in identifying the primary site in Cancer of Unknown Primary (CUP). MethOds: A decision-analytic model was developed to estimate the lifetime clinical and economic outcomes of incorporating the EPICUP assay compared with other molecular assays (CancerTYPE ID, Cancer Origin Test and ResponseDX: Tissue of Origin Test). The analysis was limited to 6 primary cancer sites (breast, colon, pancreas, lung, liver and prostate) for adenocarcinoma histological subtype. Results are presented as incremental cost-effectiveness ratio (ICER, cost per quality-adjusted life-years [QALY] gained) from the USA Health Payers perspective. Model inputs were based on a case-control study of EPICUP, published literature, Surveillance Epidemiology and End Results database and a clinical expert panel. Results: Based on a price of USD3,500 for EPICUP and for a willingness to pay USD100,000, EPICUP is cost-effective (vs. CancerTYPE ID, Cancer Origin Test and ResponseDX: Tissue of Origin Test) in all tumors analyzed, ranging between 80% and 100% of the simulations. EPICUP increased the proportion of patients treated correctly, decreased the proportion of patients treated with an empiric approach, and increased the quality-adjusted overall survival. For a willingness to pay USD50,000 EPICUP is cost-effective in breast, colon, pancreas, lung (NSCLC) and prostate cancer, again ranging between 80% and 100% of the simulations. These findings were robust across deterministic and probabilistic sensitivity analyses. cOnclusiOns: EPICUP assay for diagnosing the primary tumor in CUP patients is a cost-effective approach in breast, colon, pancreas, lung (NSCLC), hepatocellular and prostate cancer in comparison with other alternatives available, while improving patient care. PMD70 EconoMic EvAluAtion of orAl AnticoAgulAtion thErAPiEs (oAt) in chinA

Transculturalizing Diabetes Prevention in Latin America

“…Although they will need a diagnostic test either using blood glucose or glycosylated hemoglobin (HbA1c), screening by using a risk score such as FINDRISC is cost effective, as indicated by recent analysis in Colombia. 37 In this analysis, the most cost-effective strategy to screen for diabetes was using FINDRISC, followed by FBG and OGTT if necessary. 38 Although the evidence supports the screening of individuals with intermediate hyperglycemia (ie, prediabetes), it is not incorporated in the institutional screening strategies in LA.…”

Guía de práctica clínica para la prevención, diagnóstico, tratamiento y seguimiento de la diabetes mellitus tipo 2 en la población mayor de 18 años

“…In the economic evaluation to determine the most appropriate screening strategy in Colombia, as described under question 1, measurement of the glycemic index 2 hours after OGTT was compared with measurement of HbA1c as a DM diagnostic method for cases with high FINDRISC scores and abnormal fasting glycemic index. In this diagnostic sequence, the OGTT and not the HbA1c test was the most cost-effective strategy for Colombia 20 . However, the HbA1c test is of fundamental importance in deciding on initial treatment and should be administered to all subjects with a DM diagnosis (as will be seen later).…”

“…The group developing the guide also performed an economic evaluation to determine the best screening strategy for Colombia 20 . This evaluation compared schemes beginning with the fasting glucose test with schemes beginning with administration of the FINDRISC questionnaire.…”