Examine how much the disease costs the community per unit time (normally year)
Measure outcomes (life years, number of days free of illness) versus cost of treatment
What is a cost-effectiveness plane?
Quality-adjusted life years
What are quality-adjusted life years?
Compare years to a scale of quality. Scale is 0-1, with 0 being quality equivalent to being dead, 1 being completely healthy
Time to first event
Time taken to have first event (EG: Myocardial infarction, stroke). Doesn't show time between events
Why do we need complex models for diseases such as diabetes?
1) In chronic diseases it can take years for the effects of treatments to become apparent. 2) There are many different possible complications and factors influencing the course of disease
Original model for diabetes
Eastman model, from mid-1990s
Common features of disease models 1) 2) 3) 4)
1) Developed from literature or data regarding what is known of the clinical aspects and epidemiology of disease. 2) A series of health states that are important in terms of costs or impacts on quality of life. 3) Risk factors or treatments that influence the transition to these health states 4) Outcomes measured in quality-adjusted life years, life expectancy
What is HbAlc?
A measure of organ glycaemia exposure. A risk factor for type II diabetes
In model equations, what does it mean that age is assigned a value of 1.03?
For each year of age, risk of developing diabetes increases 3%
Once the data have been put into the model, how is the model run?
P value (probability) of complication is compared to a randomly-generated number between 0 and 1. If it is under the P value, then the model patient is said to have developed the complication.
Drug effective in controlling hypertension
AHEAD study outcomes
Controlling BMI helps in reducing risk of developing diabetes. Once you have diabetes, reducing BMI doesn't have much effect.
What is a hazard ratio?
A number assigned to a factor, EG: age in diabetes risk. Age+1.03, which means that with each year of age, risk of developing diabetes increases 3%
What are a high proportion of treatment costs of TIIDM from?
Population that reports the fewest problems with health
UK prospective diabetes study. A model used to investigate a set of parametric proportional hazard models, using collected data.
When do you assume an event happens in a model?
The probability of dying after an event. Decreases with time after the event
Possible new option for treating diabetes
Many drugs for treatment (EG: statins) are coming off patent. These could be used more widely, as they will be much cheaper as generics.