Patient Health Utility Equations for a Type 2 Diabetes Model

• Published in: Diabetes care Vol. 44; no. 2; pp. 381 - 389
• Main Authors: Neuwahl, Simon J, Zhang, Ping, Chen, Haiying, Shao, Hui, Laxy, Michael, Anderson, Andrea M, Craven, Timothy E, Hoerger, Thomas J
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.02.2021
• Subjects: Amputation; Angina; Angina pectoris; Cardiovascular diseases; Cardiovascular system; Cerebral infarction; Clinical trials; Complications; Congestive heart failure; Diabetes; Diabetes Complications; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Dialysis; Epidemiology/Health Services Research; Epidermal growth factor receptors; Glomerular filtration rate; Health risks; Humans; Hypoglycemia; Myocardial Infarction; Regression models; Research design; Risk management; Statistical analysis; Stroke - epidemiology; Stroke - etiology; Utilities
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc20-1207

To estimate the health utility impact of diabetes-related complications in a large, longitudinal U.S. sample of people with type 2 diabetes. We combined Health Utilities Index Mark 3 data on patients with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) and Look AHEAD (Action for Health in Diabetes) trials and their follow-on studies. Complications were classified as events if they occurred in the year preceding the utility measurement; otherwise, they were classified as a history of the complication. We estimated utility decrements associated with complications using a fixed-effects regression model. Our sample included 15,252 persons with an average follow-up of 8.2 years and a total of 128,873 person-visit observations. The largest, statistically significant ( < 0.05) health utility decrements were for stroke (event, -0.109; history, -0.051), amputation (event, -0.092; history, -0.150), congestive heart failure (event, -0.051; history, -0.041), dialysis (event, -0.039), estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m (event, -0.043; history, -0.025), angina (history, -0.028), and myocardial infarction (MI) (event, -0.028). There were smaller effects for laser photocoagulation and eGFR <60 mL/min/1.73 m . Decrements for dialysis history, angina event, MI history, revascularization event, revascularization history, laser photocoagulation event, and hypoglycemia were not significant ( ≥ 0.05). With use of a large study sample and a longitudinal design, our estimated health utility scores are expected to be largely unbiased. Estimates can be used to describe the health utility impact of diabetes complications, improve cost-effectiveness models, and inform diabetes policies.