Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA 1c , weight and hypoglycaemic event incidence

• Published in: Diabetic medicine 2018-05, Vol.35 (5), p.557-566
• Main Authors: McEwan, P, Bennett, H, Bolin, K, Evans, M, Bergenheim, K
• Format: Article
• Language: English
• Subjects: Adult; Body Mass Index; Cost-Benefit Analysis; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - economics; Disease Management; Female; Glycated Hemoglobin A - metabolism; Health Care Costs; Humans; Hypoglycemia - chemically induced; Hypoglycemia - economics; Hypoglycemia - epidemiology; Hypoglycemic Agents - economics; Hypoglycemic Agents - therapeutic use; Insulin - economics; Insulin - therapeutic use; Male; Quality-Adjusted Life Years; United Kingdom; Weight Gain
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.13590

Insulin therapy is indicated for people with Type 1 diabetes mellitus; however, treatment-related weight gain and hypoglycaemia represent barriers to optimal glycaemic management. This study assessed the health economic value of maintained reductions in HbA , BMI and hypoglycaemia incidence among the UK Type 1 diabetes population. The Cardiff Type 1 Diabetes Model was used to estimate lifetime costs, life-years and quality-adjusted life-years (QALYs) for individuals with Type 1 diabetes at different baseline HbA , BMI and hypoglycaemic event rates. Results were discounted at 3.5%, and the net monetary benefit associated with improving Type 1 diabetes management was derived at £20 000/QALY gained. Per-person outputs were inflated to national levels using UK Type 1 diabetes prevalence estimates. Modelled subjects with an HbA of 86 mmol/mol (10.0%) were associated with discounted lifetime per-person costs of £23 795; £12 649 of which may be avoided by maintaining an HbA of 42 mmol/mol (6.0%). Combined with estimated QALY gains of 2.80, an HbA of 42 mmol/mol (6.0%) vs. 86 mmol/mol (10.0%) was associated with a £68 621 per-person net monetary benefit. Over 1 year, unit reductions in BMI produced £120 per-person net monetary benefit, and up to £197 for the avoidance of one non-severe hypoglyceamic event. Maintained reductions in HbA significantly alleviate the burden associated with Type 1 diabetes in the UK. Given the influence of weight and hypoglycaemia on health economic outcomes, they must also be key considerations when assessing the value of Type 1 diabetes technologies in clinical practice.