The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program

Neumann, Anne; Lindholm, Lars; Norberg, Margareta; Schoffer, Olaf; Klug, Stefanie J.; Norström, Fredrik

doi:10.1007/s10198-016-0851-9

Cited by 33 publications

(26 citation statements)

References 44 publications

(82 reference statements)

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“…An overview of each model is outlined in Table 1, sorted by year of publication. Models were set in the USA (n = 6, 21%), 29,30,32,42,44,50 the UK (n = 3, 10%), 35,51,52 Australia (n = 3, 10%), 34,37,46 other European countries (n = 7, 24%), 33,36,39,41,43,47,54 the Americas (n = 3, 10%), 27,38,45 Asia (n = 5, 17%) 40,48,49,53,55 and in multiple countries (n = 2, 7%). 28,31 The type of intervention evaluated included screening programmes (n = 3, 10%), interventions (lifestyle and/or pharmacological) (n = 8, 28%), screening plus intervention (n = 17, 59%) and current care only (n = 1, 3%) (more detail in Appendix S2; Supporting Information Table SA.2.1).…”

Section: Resultsmentioning

confidence: 99%

Decision models of prediabetes populations: A systematic review

Leal

Morrow

Khurshid

et al. 2019

Diabetes Obesity Metabolism

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Aims With evidence supporting the use of preventive interventions for prediabetes populations and the use of novel biomarkers to stratify the risk of progression, there is a need to evaluate their cost‐effectiveness across jurisdictions. Our aim is to summarize and assess the quality and validity of decision models and model‐based economic evaluations of populations with prediabetes, to evaluate their potential use for the assessment of novel prevention strategies and to discuss the knowledge gaps, challenges and opportunities. Materials and methods We searched Medline, Embase, EconLit and NHS EED between 2000 and 2018 for studies reporting computer simulation models of the natural history of individuals with prediabetes and/or we used decision models to evaluate the impact of treatment strategies on these populations. Data were extracted following PRISMA guidelines and assessed using modelling checklists. Two reviewers independently assessed 50% of the titles and abstracts to determine whether a full text review was needed. Of these, 10% was assessed by each reviewer to cross‐reference the decision to proceed to full review. Using a standardized form and double extraction, each of four reviewers extracted 50% of the identified studies. Results A total of 29 published decision models that simulate prediabetes populations were identified. Studies showed large variations in the definition of prediabetes and model structure. The inclusion of complications in prediabetes (n = 8) and type 2 diabetes (n = 17) health states also varied. A minority of studies simulated annual changes in risk factors (glycaemia, HbA1c, blood pressure, BMI, lipids) as individuals progressed in the models (n = 7) and accounted for heterogeneity among individuals with prediabetes (n = 7). Conclusions Current prediabetes decision models have considerable limitations in terms of their quality and validity and do not allow evaluation of stratified strategies using novel biomarkers, highlighting a clear need for more comprehensive prediabetes decision models.

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Section: Resultsmentioning

confidence: 99%

Decision models of prediabetes populations: A systematic review

Leal

Morrow

Khurshid

et al. 2019

Diabetes Obesity Metabolism

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“…Among prevention, about 20% of the topics were allocated to primary prevention while the remaining 80% focused on secondary prevention such as screening tests. Teaching on topics about primary prevention, however, could be more beneficial for future doctors as primary prevention measures bear a larger and cost-effective impact within public health [36][37][38][39]. Surprisingly, pregnancy-related themes such as prenatal diagnostics were used as risk communication topics as often as cancer although they are ethically debatable, usually not paid by insurance companies, relevant only for pregnant women/their relatives and detect only 2% of genetically transmitted diseases; whereas cancerrelated health problems carry a much heavier burden [40,41].…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk communication teaching in psychosocial and other medical departments

Baessler

Zafar

Ciprianidis

et al. 2020

Medical Education Online

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Aims: Teaching students about risk communication is an important aspect at medical schools given the growing importance of informed consent in healthcare. This observational study analyzes the quality of teaching content on risk communication and biostatistics at a medical school. Methods: Based on the concept of curriculum mapping, purpose-designed questionnaires were used via participant observers to record the frequency, characteristics and context of risk communication employed by lecturers during teaching sessions for one semester. The data was analyzed quantitatively and descriptively. Results: Teaching about risk communication was observed in 24.4% (n = 95 of 390) sessions. Prevalence varied significantly among different departments with dermatology having the highest rate (67.9%) but lesser in-depth teaching than medical psychology where risk communication concepts were discussed on a higher scale in 61.4% sessions. Relevant statistical values were not mentioned at all in 69% of these 95 sessions and clinical contexts were used rarely (55.8%). Supplementary teaching material was provided in 50.5% sessions while students asked questions in 18.9% sessions. Conclusions: Students are infrequently taught about communicating risks. When they are, the teaching does not include the mention of core biostatistics values nor does the teaching involve methods for demonstrating risk communication.

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“…43 [38] used a €35,000/QALY threshold, while D'Andrea et al [39] and Areia et al [40] set a threshold of €37,000/QALY in Italy and Portugal, respectively. However, Neuman et al [41] and Naber et al [42] considered a higher cost-utility threshold (€50,000/QALY). According to the cost-utility thresholds used in these studies, providing a germline BRCA1/2 testing to HGEOC patients without family history of OC or BC and their gBRCA1/2m-positive relatives is cost-effective in Spain.…”

Section: Discussionmentioning

confidence: 99%

“…Our results of the one-way sensitivity analyses were not substantially different from the base case, and most of them were below the €37,000/QALY threshold. Besides, our PSA showed that 52.52% of our simulations fell below the €35,000/QALY threshold, 60.56% were below the €37,000/QALY threshold, and 89.12% were below the €50,000/QALY threshold [38][39][40][41][42].…”

Section: Discussionmentioning

confidence: 99%

Cost–utility analysis of germline BRCA1/2 testing in women with high-grade epithelial ovarian cancer in Spain

et al. 2019

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Purpose Germline mutations in BRCA1 and/or BRCA2 genes (gBRCA1/2m) are associated with an increased risk of breast cancer (BC) and ovarian cancer (OC). The aim of this study was to estimate the efficiency of providing germline BRCA1/2 testing to high-grade epithelial ovarian cancer (HGEOC) patients without family history of OC or BC and the subsequent testing and management of their relatives with gBRCA1/2m in Spain. Methods/patients Incident HGEOC patients without family history of OC or BC who were gBRCA1/2m carriers and their relatives were simulated in a 50-year time horizon. The study compared two scenarios: BRCA1/2 testing vs no testing, using the perspective of the Spanish National Health Service. Cancer risk among gBRCA1/2m carriers was estimated based on their age and whether they had undergone risk-reducing surgeries. Direct healthcare costs and utilities of patients who developed EOC and BC were also included. A probabilistic sensitivity analysis (PSA) with 5 thousand simulations was developed considering ± 25% of the base-case value. Results The BRCA1/2-testing scenario amounted to €13,437,897.43 while the no-testing scenario amounted to €12,053,291.17. It was estimated that the screening test improved the quality of life among the patients' relatives by 43.8 quality-adjusted life years (QALYs). The incremental cost-utility ratio (ICUR) was €31,621.33/QALY in the base case. The PSA showed that 89.12% of the simulations were below the €50,000/QALY threshold. Conclusion Providing this screening test to HGEOC patients and their relatives is cost-effective and it allows one to identify a target population with high risk of cancer to provide effective prevention strategies.

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The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program

Cited by 33 publications

References 44 publications

Decision models of prediabetes populations: A systematic review

Decision models of prediabetes populations: A systematic review

Analysis of risk communication teaching in psychosocial and other medical departments

Cost–utility analysis of germline BRCA1/2 testing in women with high-grade epithelial ovarian cancer in Spain

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