Seminar:Cost-effectiveness of monitoring renal function for patients with type 1 and type 2 diabetes
15 February 2012
Full title: Cost-effectiveness of monitoring renal function for patients with type 1 and type 2 diabetes in the United Kingdom
Speaker: Tom Lung, School of Public Health
Objectives: To evaluate the cost-effectiveness of alternative monitoring programmes for renal function in patients with type 1 and type 2 diabetes in a UK context. A discrete-event simulation model was developed for people with type 1 diabetes and an existing type 2 diabetes simulation model was adapted to estimate mean life expectancy and quality-adjusted life years (QALYs) over a lifetime associated with various renal screening programmes.
Methods: We synthesized evidence on type 1 diabetes patients using several published sources. The simulation model was based on eleven equations to estimate transitions between health states. We adapted an existing diabetes simulation model (UKPDS Outcomes Model) for type 2 diabetes using literature on the stratification of cardiovascular and mortality risk by renal function levels. Monitoring intervals were varied to 2, 3, 4, 5 and 10 yearly intervals and compared to the baseline case of annual screening (current UK guidelines). Outcomes were expressed in quality adjusted life years to capture both increases in life expectancy and improved quality of life. QALYs from different diabetes complications were obtained from a meta-analysis. Costs were included in the analysis. Costs of the monitoring program and treatment were provided from the UK guidelines, and hospitalisation from diabetes-related complications was obtained from a recent UK study. Results were presented as incremental cost-effectiveness analyses for both type 1 and type 2 simulation models. 1000 patients were simulated for 85 and 30 years for type 1 and type 2 diabetes, respectively.
Results: When comparing annual screening to biennial screening, both costs and QALYs were reduced from the base case, showing an incremental cost-effectiveness ratio of £9,718 per QALY and £512 per QALY for type 1 and type 2 diabetes, respectively. Increasing the screening interval up to 5 yearly intervals will see reductions in both costs and QALYs in both groups, at an incremental cost-effectiveness ratio well within NICE's recommended cost per QALY threshold. The sensitivity analyses showed that universal treatment had better survival rates than annual screening.
Conclusions: Renal screening for people with type 1 and type 2 diabetes is cost-effective in the UK context compared to other funded health interventions. Further research is required to determine whether universal treatment is a policy that is worth pursuing in the long term.
Hosted by Screening & Test Evaluation Program (STEP), School of Public Health
Time: 1 - 2pm
Location: Chemistry Lecture Theatre 4, University of Sydney
Contact: Jessica Frazer
Phone: 02 9351 5994