Modelling the Economics of Type 2 Diabetes Mellitus Prevention: A Literature Review of Methods

Watson, P.; Preston, Louise; Squires, Hazel; Chilcott, James; Brennan, Alan

doi:10.1007/s40258-014-0091-z

Cited by 18 publications

(10 citation statements)

References 91 publications

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“…The model was originally developed using a new conceptual modelling framework for complex public health models, 273 in collaboration with a project stakeholder group comprising health economists, public health specialists, research collaborators from other SPHR groups, diabetologists, local commissioners and lay members. A review of existing diabetes prevention models was undertaken to inform conceptual model development, 274 resulting in the model including multiple diabetes risk factors (in particular both BMI and impaired fasting glucose) and complications of diabetes and obesity.…”

Section: Implementation Of Mapping Steps To Risk Factorsmentioning

confidence: 99%

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Dunkley

Tyrer

Spong

et al. 2017

Programme Grants Appl Res

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BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

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Section: Implementation Of Mapping Steps To Risk Factorsmentioning

confidence: 99%

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Dunkley

Tyrer

Spong

et al. 2017

Programme Grants Appl Res

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“…However, it is necessary to consider various risk factors for diabetes, including related complications and comorbidities. Watson et al [29] reviewed over 100 studies and concluded that, "None of the identified papers included all of these features" ( [29], p. 250). Therefore, we employed regression-type models.…”

Section: Models For the Analysis Of Losmentioning

confidence: 99%

Comparison of the Length of Stay and Medical Expenditures among Japanese Hospitals for Type 2 Diabetes Treatments: The Box-Cox Transformation Model under Heteroscedasticity

Nawata¹,

Kawabuchi²

2016

Health

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In this paper, we analyzed length of stay (LOS) in hospitals and medical expenditures for type 2 diabetes patients. LOS was analyzed by the power Box-Cox transformation model when variances differed among hospitals. We proposed a new test and consistent estimator. We rejected the homoscedasticity of variances among hospitals, and then analyzed the LOS of 12,666 type 2 diabetes patients hospitalized for regular medical treatments collected from 60 general hospitals in Japan. The variables found to affect LOS were age, number of comorbidities and complications, introduced by another hospital, one-week hospitalization, 2010 revision, specific-hospitalization-period (SHP), and principal diseases E11.5, E11.6 and E11.7. There were surprisingly large differences in ALOS among hospitals even after eliminating the influence of characteristics and conditions of patients. We then analyzed daily medical expenditure (DME) by the ordinary least squares methods. The variables that affected DME were LOS, number of comorbidities and complications, acute hospitalization, hospital's own outpatient, season, introduced by another hospital, one-week hospitalization, 2010 revision, SHP, time trend, and principal diseases E11.2, E11.4 and E117. The DME did not decrease after the SHP. After eliminating the influences of characteristics and conditions of patients, the differences among hospitals were relatively small, 12% of the overall average. LOS is the main determinant of medical expenditures, and new incentives to reduce LOS are needed to control Japanese medical expenditures. Since at least 99% of patients require medical care after leaving the hospital, systems that take proper care of patients for long periods of time after hospitalization are absolutely necessary for efficient treatment of diabetes.K. Nawata, K. Kawabuchi 50

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“…However, because of differences in the model structures used, it has not been possible to compare their relative cost‐effectiveness. A recent review of economic evaluations for diabetes prevention interventions identified that to compare prevention interventions within a common framework it is necessary to incorporate multiple risk factors for diabetes, diabetes‐related complications and obesity‐related comorbidity outcomes .…”

Section: Introductionmentioning

confidence: 99%

The impact of Type 2 diabetes prevention programmes based on risk‐identification and lifestyle intervention intensity strategies: a cost‐effectiveness analysis

et al. 2017

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Aims To develop a cost-effectiveness model to compare Type 2 diabetes prevention programmes targeting different at-risk population subgroups with a lifestyle intervention of varying intensity.Methods An individual patient simulation model was constructed to simulate the development of diabetes in a representative sample of adults without diabetes from the UK population. The model incorporates trajectories for HbA 1c , 2-h glucose, fasting plasma glucose, BMI, systolic blood pressure, total cholesterol and HDL cholesterol. Patients can be diagnosed with diabetes, cardiovascular disease, microvascular complications of diabetes, cancer, osteoarthritis and depression, or can die. The model collects costs and utilities over a lifetime horizon. The perspective is the UK National Health Service and personal social services. We used the model to evaluate the population-wide impact of targeting a lifestyle intervention of varying intensity to six population subgroups defined as high risk for diabetes.Results The intervention produces 0.0003 to 0.0009 incremental quality-adjusted life years and saves up to £1.04 per person in the general population, depending upon the subgroup targeted. Cost-effectiveness increases with intervention intensity. The most cost-effective options are to target individuals with HbA 1c > 42 mmol/mol (6%) or with a high Finnish Diabetes Risk (FINDRISC) probability score (> 0.1). ConclusionThe model indicates that diabetes prevention interventions are likely to be cost-effective and may be costsaving over a lifetime. In the model, the criteria for selecting at-risk individuals differentially impact upon diabetes and cardiovascular disease outcomes, and on the timing of benefits. These findings have implications for deciding who should be targeted for diabetes prevention interventions.

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Modelling the Economics of Type 2 Diabetes Mellitus Prevention: A Literature Review of Methods

Cited by 18 publications

References 91 publications

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Comparison of the Length of Stay and Medical Expenditures among Japanese Hospitals for Type 2 Diabetes Treatments: The Box-Cox Transformation Model under Heteroscedasticity

The impact of Type 2 diabetes prevention programmes based on risk‐identification and lifestyle intervention intensity strategies: a cost‐effectiveness analysis

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