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The validity of cost-effectiveness analyses of tight glycemic control. A systematic survey of economic evaluations of pharmacological interventions in patients with type 2 diabetes

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Abstract

Purpose

Currently available randomized trial evidence has shown no reductions in type 2 diabetes (T2D) complications important to patients with tight glycemic control. Yet, economic analyses consistently find tight glycemic control to be cost-effective. To understand this apparent paradox, we systematically identified and appraised economic analyses of tight glycemic control for T2D.

Methods

We searched multiple databases from January 2016 to January 2018 for cost-effectiveness or cost-utility analyses of any glucose-lowering treatments for adults with T2D using simulations with long—40 years to lifetime—time horizons. Reviewers selected and appraised each study independently and in duplicate with good reproducibility.

Results

We found 30 analyses, most comparing the glycemic impact of glucose-lowering drugs and applying their impact on HbA1c to model (most commonly IMS CORE or Cardiff T2DM) their impact on the incidence of diabetes-related complication. Models drew from observational evidence of the correlation of HbA1c levels and diabetes-related complication rates; none used estimates of the effect of lowering HbA1c on these outcomes from systematic reviews of randomized trials. Sensitivity analyses, when conducted, demonstrate substantial loss of cost-effectiveness as simulations approach the results seen in these trials.

Conclusions

Reliance on the association between glycemic control and diabetes-related complications evident in observational studies but not apparent in randomized trial bias the estimates of the cost-effectiveness of interventions to improve glycemic control.

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Authors and Affiliations

  1. Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Francisco J. Barrera, Freddy JK. Toloza, Oscar J. Ponce, Rene Rodriguez-Gutierrez & Victor M. Montori

  2. Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico

    Francisco J. Barrera, Jorge A. Zuñiga-Hernandez & Rene Rodriguez-Gutierrez

  3. Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Freddy JK. Toloza

  4. Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru

    Oscar J. Ponce

  5. Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA

    Larry J. Prokop

  6. Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Nilay D. Shah

  7. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Gordon Guyatt

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  1. Francisco J. Barrera
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  9. Victor M. Montori
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Contributions

F.J.B.: conceptualization, methodology, formal analysis, investigation, data curation, writing—original draft, visualization. F.J.K.T.: formal analysis, investigation, data curation. O.J.P.: formal analysis, visualization, writing—review and editing. J.A.Z-H.: formal analysis, data curation, visualization. L.J.P.: software, resources. N.D.S.: methodology, validation, writing—review and editing, visualization. G.G.: methodology, validation, writing—review and editing, visualization. R.R-G.: conceptualization, methodology, validation, visualization, writing—review and editing, supervision, project administration. V.M.M.: conceptualization, methodology, validation, visualization, writing—review and editing, supervision, project administration.

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Correspondence to Victor M. Montori.

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Barrera, F.J., Toloza, F.J., Ponce, O.J. et al. The validity of cost-effectiveness analyses of tight glycemic control. A systematic survey of economic evaluations of pharmacological interventions in patients with type 2 diabetes. Endocrine 71, 47–58 (2021). https://doi.org/10.1007/s12020-020-02489-w

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