Estimating the cost-effectiveness of lifestyle intervention programmes to prevent diabetes based on an example from Germany Markov modelling.docVIP

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Estimating the cost-effectiveness of lifestyle intervention programmes to prevent diabetes based on an example from Germany Markov modelling.doc

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Estimating the cost-effectiveness of lifestyle intervention programmes to prevent diabetes based on an example from Germany Markov modelling

Neumannetal.CostEffectivenessandResourceAllocation2011,9:17 /content/9/1/17 RESEARCH OpenAccess Estimatingthecost-effectivenessoflifestyle interventionprogrammestopreventdiabetes basedonanexamplefromGermany:Markov modelling AnneNeumann1,2*,PeterSchwarz3andLarsLindholm1 Abstract Background:Type2diabetesmellitus(T2D)posesalargeworldwideburdenforhealthcaresystems.Onepossible tooltodecreasethisburdenisprimaryprevention.Asitisunethicaltowaituntilperfectdataareavailableto concludewhetherT2Dprimarypreventioninterventionprogrammesarecost-effective,weneedamodelthat simulatestheeffectofpreventioninitiatives.Thus,theaimofthisstudyistoinvestigatethelong-termcost- effectivenessoflifestyleinterventionprogrammesforthepreventionofT2DusingaMarkovmodel.Asdecision makersoftenfacedifficultiesinapplyinghealtheconomicresults,wevisualiseourresultswithhealtheconomic tools. Methods:Weusefour-stateMarkovmodellingwithaprobabilisticcohortanalysistocalculatethecostperquality- adjustedlifeyear(QALY)gained.Aone-yearcyclelengthandalifetimetimehorizonareapplied.Bestavailable evidencesuppliesthemodelwithdataontransitionprobabilitiesbetweenglycaemicstates,mortalityrisks,utility weights,anddiseasecosts.Thecostsarecalculatedfromasocietalperspective.A3%discountrateisusedfor costsandQALYs.Cost-effectivenessacceptabilitycurvesarepresentedtoassistdecisionmakers. Results:Themodelindicatesthatdiabetespreventioninterventionshavethepotentialtobecost-effective,butthe outcomerevealsahighlevelofuncertainty.Incrementalcost-effectivenessratios(ICERs)werenegativeforthe intervention,ie,theinterventionleadstoacostreductionformenandwomenaged30or50yearsatinitiationof theintervention.Formenandwomenaged70atinitiationoftheintervention,theICERwasEUR27,546/QALY gainedandEUR19,433/QALYgained,respectively.Inallcases,theQALYsgainedwerelow.Cost-effectiveness acceptabilitycurvesshowthatthehigherthewillingness-to-paythresholdvalue,thehighertheprobabilitythatthe interventioniscost-effective.Nonetheless,allcurvesareflat.Thethresho