A New Type 2 Diabetes Microsimulation Model to Estimate Long-Term Health Outcomes, Costs, and Cost-Effectiveness

Details

• Alternative Title:
  Value Health
• Personal Author:
  Hoerger, Thomas J. ; Hilscher, Rainer ; Neuwahl, Simon ; Kaufmann, Matthew B. ; Shao, Hui ; Laxy, Michael ; Cheng, Yiling J. ; Benoit, Stephen ; Chen, Haiying ; Anderson, Andrea ; Craven, Tim ; Yang, Wenya ; Cintina, Inna ; Staimez, Lisa ; Zhang, Ping
• Corporate Authors:
  Look AHEAD Research Group
• Description:
  Objectives:
  
  This study aimed to develop a microsimulation model to estimate the health effects, costs, and cost-effectiveness of public health and clinical interventions for preventing/managing type 2 diabetes.
  
  Methods:
  
  We combined newly developed equations for complications, mortality, risk factor progression, patient utility, and cost—all based on US studies—in a microsimulation model. We performed internal and external validation of the model. To demonstrate the model’s utility, we predicted remaining life-years, quality-adjusted life-years (QALYs), and lifetime medical cost for a representative cohort of 10 000 US adults with type 2 diabetes. We then estimated the cost-effectiveness of reducing hemoglobin A1c from 9% to 7% among adults with type 2 diabetes, using low-cost, generic, oral medications.
  
  Results:
  
  The model performed well in internal validation; the average absolute difference between simulated and observed incidence for 17 complications was < 8%. In external validation, the model was better at predicting outcomes in clinical trials than in observational studies. The cohort of US adults with type 2 diabetes was projected to have an average of 19.95 remaining life-years (from mean age 61), incur $187 729 in discounted medical costs, and accrue 8.79 discounted QALYs. The intervention to reduce hemoglobin A1c increased medical costs by $1256 and QALYs by 0.39, yielding an incremental cost-effectiveness ratio of $9103 per QALY.
  
  Conclusions:
  
  Using equations exclusively derived from US studies, this new microsimulation model achieves good prediction accuracy in US populations. The model can be used to estimate the long-term health impact, costs, and cost-effectiveness of interventions for type 2 diabetes in the United States.
  
  
• Subjects:
  Adult Cost-Benefit Analysis Diabetes Mellitus, Type 2 Glycated Hemoglobin Humans Middle Aged Outcome Assessment, Health Care Quality-Adjusted Life Years
• Keywords:
  Diabetes Microsimulation Probabilistic Sensitivity Analysis Risk Equations
• Source:
  Value Health. 26(9):1372-1380
• Pubmed ID:
  37236396
• Pubmed Central ID:
  PMC11017333
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Place as Subject:
  United States
• Volume:
  26
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:05ce3d336e1d90c6930c030830810f686abbad211fce69269f71bc1d412f3883
• Download URL:
  https://stacks.cdc.gov/view/cdc/154386/cdc_154386_DS1.pdf
• File Type:
  [PDF - 568.75 KB ]