Michael Laxy1, Jana Becker2, Katharina Kähm3, Rolf Holle4, Annette Peters5, Barbara Thorand5, Lars Schwettmann6, Florian M Karl3. 1. Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Centre for Diabetes Research (DZD), Neuherberg, Germany; Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA. Electronic address: michael.laxy@helmholtz-muenchen.de. 2. Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, WHO Collaborating Centre for Occupational Health, University Hospital Munich, Munich, Germany. 3. Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Centre for Diabetes Research (DZD), Neuherberg, Germany. 4. Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; German Centre for Diabetes Research (DZD), Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany. 5. German Centre for Diabetes Research (DZD), Neuherberg, Germany; Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany. 6. Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Abstract
OBJECTIVES: Health utility decrement estimates for diabetes and complications are needed for parametrization of simulation models that aim to assess the cost-utility of diabetes prevention and care strategies. This study estimates health utility decrements associated with diabetes and cardiovascular and microvascular complications from a population-based German study. METHODS: Data were obtained from the population based cross-sectional KORA (Cooperative Health Research in the Augsburg Region) health questionnaire 2016 and comprised n = 1072 individuals with type 2 diabetes and n = 7879 individuals without diabetes. Health utility was assessed through the EQ-5D-5L. We used linear regression models with interaction terms between type 2 diabetes and different cardiovascular and microvascular complications while adjusting for demographic and socio-economic factors and other comorbidities. RESULTS: Type 2 diabetes (β = -0.028, standard error [SE] = 0.014), stroke (β = -0.070, SE = 0.010), cardiac arrhythmia (β = -0.031, SE = 0.006), heart failure (β = -0.073, SE = 0.009), coronary heart disease (β = -0.028, SE = 0.010), myocardial infarction (β = -0.020, SE = 0.011, estimates of main effect), and neuropathy (β = -0.067, SE = 0.020), diabetic foot (β = -0.042, SE = 0.030), nephropathy (β = -0.032, SE = 0.025), and blindness (β = -0.094, SE = 0.056, estimates of interaction terms) were negatively associated with health utility. The interaction term for diabetes x stroke (β = -0.052, SE = 0.021) showed that the utility decrement for stroke is significantly larger in people with type 2 diabetes than in people without diabetes. CONCLUSIONS: Diabetes, cardiovascular, and microvascular conditions are associated with significant health utility decrements. Utility decrements for some conditions differ between people with and without type 2 diabetes. These results are of high relevance for the parametrization of decision analytic simulation models and applied health economic evaluations in the field of prevention and management of type 2 diabetes in Germany.
OBJECTIVES: Health utility decrement estimates for diabetes and complications are needed for parametrization of simulation models that aim to assess the cost-utility of diabetes prevention and care strategies. This study estimates health utility decrements associated with diabetes and cardiovascular and microvascular complications from a population-based German study. METHODS: Data were obtained from the population based cross-sectional KORA (Cooperative Health Research in the Augsburg Region) health questionnaire 2016 and comprised n = 1072 individuals with type 2 diabetes and n = 7879 individuals without diabetes. Health utility was assessed through the EQ-5D-5L. We used linear regression models with interaction terms between type 2 diabetes and different cardiovascular and microvascular complications while adjusting for demographic and socio-economic factors and other comorbidities. RESULTS:Type 2 diabetes (β = -0.028, standard error [SE] = 0.014), stroke (β = -0.070, SE = 0.010), cardiac arrhythmia (β = -0.031, SE = 0.006), heart failure (β = -0.073, SE = 0.009), coronary heart disease (β = -0.028, SE = 0.010), myocardial infarction (β = -0.020, SE = 0.011, estimates of main effect), and neuropathy (β = -0.067, SE = 0.020), diabetic foot (β = -0.042, SE = 0.030), nephropathy (β = -0.032, SE = 0.025), and blindness (β = -0.094, SE = 0.056, estimates of interaction terms) were negatively associated with health utility. The interaction term for diabetes x stroke (β = -0.052, SE = 0.021) showed that the utility decrement for stroke is significantly larger in people with type 2 diabetes than in people without diabetes. CONCLUSIONS:Diabetes, cardiovascular, and microvascular conditions are associated with significant health utility decrements. Utility decrements for some conditions differ between people with and without type 2 diabetes. These results are of high relevance for the parametrization of decision analytic simulation models and applied health economic evaluations in the field of prevention and management of type 2 diabetes in Germany.
Authors: Michelle Tew; Michael Willis; Christian Asseburg; Hayley Bennett; Alan Brennan; Talitha Feenstra; James Gahn; Alastair Gray; Laura Heathcote; William H Herman; Deanna Isaman; Shihchen Kuo; Mark Lamotte; José Leal; Phil McEwan; Andreas Nilsson; Andrew J Palmer; Rishi Patel; Daniel Pollard; Mafalda Ramos; Fabian Sailer; Wendelin Schramm; Hui Shao; Lizheng Shi; Lei Si; Harry J Smolen; Chloe Thomas; An Tran-Duy; Chunting Yang; Wen Ye; Xueting Yu; Ping Zhang; Philip Clarke Journal: Med Decis Making Date: 2021-12-15 Impact factor: 2.749