Modeling the Efficiency of Reaching a Target Intermediate End Point: A Case Study in Type 2 Diabetes in the United States

Authors: Caro J.J.; Salas M.¹; O'Brien J.A.²; Ishak K.³; Sung J.⁴; Raggio G.²

Source: Value in Health, Volume 7, Number 1, January 2004 , pp. 13-21(9)

Publisher: Wiley-Blackwell

Abstract:

Objective:

The objective of this study was to describe an approach to modeling the efficiency of an intervention by focusing on an established intermediate end point directly. A case study addresses the economic efficiency of obtaining dual glycemic control over time, according to initial choice of treatment. Methods:

From the perspective of a payer in the United States, instead of the usual approach of basing the model on projecting long-term diabetic complications from glycemic control, this model focuses directly on glycemic control. Treatment changes and associated health-care utilization needed to address postprandial glucose. After assigning each of 10,000 drug-naïve patients, HbA_1c, age, race, and sex based on distributions from a randomized clinical trial, the model applies the efficacy of nateglinide compared to metformin. Sensitivity analyses were carried out for all parameters. Costs are reported in year 2000 US dollars and discounted at 3%. Results:

In the base case, starting on nateglinide and increasing the time in dual glycemic control over 3 years by 2.4 months led to savings of US $295 compared to starting on metformin. Savings increased with stricter treatment criteria but decreased if glycemic control was better initially. Conclusions:

This study illustrates the use of an efficiency model that focuses directly on the relevant short-term end point: glycemic control. Starting patients with nateglinide is shown to be an efficient way of obtaining dual glycemic control during the first 3 years of treatment.

Keywords: modeling; diabetes; glycemia; economic

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1524-4733.2004.71249.x

Affiliations: 1: Division of Internal Medicine, McGill University, Montreal, Quebec, Canada; 2: Caro Research Institute, Concord, MA, USA; 3: Caro Research Institute, Montreal, Quebec, Canada; 4: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA

Publication date: 2004-01-01

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