Optimization of the Health Economic Model of Type 2 Diabetes Based on Glycemic Variability Mechanism

OBJECTIVES: As the global burden of type 2 diabetes(T2DM) increases, the economic evaluation of drugs becomes important. Many health economic models were used to estimate cost-effectiveness. However, glycemic variability has rarely been considered in these research, which will inevitably lead to an underestimation of innovative drugs’value. This study aims to optimize the health economic model based on the mechanism of glycemic variability so as to provide a suitable tool for evaluating novel antidiabetic drugs.

METHODS: This study used the Monte Carlo Markov model method, and the main data sources were from the UKPDS study. Time in range （TIR） was used as the measure of glycemic variability, for which systematical clinical evidences were used for glycemic variability module. The basic model was remarked by face validity, external validity, internal validity, and cross-validation. For validating the glycemic variability module, this study estimated the long-term health outcomes of patients using a certain hypoglycemic drug with one-year treatment. The increase for patients in TIR of treatment was set at 0%, 25%, 50%, 75% and 100%, respectively.

RESULTS: Basic model validation results showed the reliability of the model: The face validity was good. The results of internal, external and cross-validation all show that F-test was less than 0.001, and R² was over 0.900. For the internal, cross, and external validation, the RMSPE was 0.013, 0.019 and 0.038, while the SMAPE was 0.065, 0.063 and 0.121, respectively.

About the glycemic variability module, for the first decade, the cumulative incidence of retinopathy, macroproteinuria, and death decreased, as the patient’s TIR improved. However, the incidence gap narrowed in the long run, which is consistent with clinical practice results.

CONCLUSIONS: In this study, the health economic model of diabetes was optimized based on the glycemic variability mechanism, which provides a reasonable tool for the economic evaluation.