The validity of cost-effectiveness analyses of tight glycemic control. A systematic survey of economic evaluations of ph
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The validity of cost-effectiveness analyses of tight glycemic control. A systematic survey of economic evaluations of pharmacological interventions in patients with type 2 diabetes Francisco J. Barrera 1,2 Freddy JK. Toloza1,3 Oscar J. Ponce1,4 Jorge A. Zuñiga-Hernandez2 Larry J. Prokop Nilay D. Shah6 Gordon Guyatt7 Rene Rodriguez-Gutierrez1,2 Victor M. Montori 1 ●
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Received: 11 July 2020 / Accepted: 31 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Currently available randomized trial evidence has shown no reductions in type 2 diabetes (T2D) complications important to patients with tight glycemic control. Yet, economic analyses consistently find tight glycemic control to be cost-effective. To understand this apparent paradox, we systematically identified and appraised economic analyses of tight glycemic control for T2D. Methods We searched multiple databases from January 2016 to January 2018 for cost-effectiveness or cost-utility analyses of any glucose-lowering treatments for adults with T2D using simulations with long—40 years to lifetime—time horizons. Reviewers selected and appraised each study independently and in duplicate with good reproducibility. Results We found 30 analyses, most comparing the glycemic impact of glucose-lowering drugs and applying their impact on HbA1c to model (most commonly IMS CORE or Cardiff T2DM) their impact on the incidence of diabetes-related complication. Models drew from observational evidence of the correlation of HbA1c levels and diabetes-related complication rates; none used estimates of the effect of lowering HbA1c on these outcomes from systematic reviews of randomized trials. Sensitivity analyses, when conducted, demonstrate substantial loss of cost-effectiveness as simulations approach the results seen in these trials. Conclusions Reliance on the association between glycemic control and diabetes-related complications evident in observational studies but not apparent in randomized trial bias the estimates of the cost-effectiveness of interventions to improve glycemic control. Keywords Type 2 diabetes Economic evaluation Cost effectiveness analysis Intensive glycemic control Health economics Health policy ●
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Introduction
Supplementary information The online version of this article (https:// doi.org/10.1007/s12020-020-02489-w) contains supplementary material, which is available to authorized users.
Type 2 diabetes (T2D) is a leading cause of morbimortality and impaired health-related quality of life (QoL) [1]. The 2017 estimated US and global cost of diabetes is US$ 327 billion—one in four US health care dollars [2]—and US 727 billion, respectively.
* Victor M. Montori [email protected]
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Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru
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Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Roches
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