Cost‐Effectiveness of Interventions for the Prevention and Control of Diabetes
Bibliographic record
Abstract
This chapter describes the conceptual framework of cost-effectiveness analysis and summarizes the results of recent studies concerning the cost-effectiveness of interventions for the prevention and control of diabetes. We reviewed original research articles published in English from 1985 through 2005, converted all costs described in these articles to 2005 US dollars and reported cost-effectiveness results separately for the United States and for other developed countries (mainly countries in Europe plus Canada and Australia). Both levels of evidence and of cost-effectiveness varied by intervention. This variation also depended on region because of differences in availability of clinical trial data as well as the availability and quality of the studies. There was strong evidence to demonstrate the following interventions were either cost-saving or cost-effective. For both the United States and other regions, these interventions include (1) intensive lifestyle interventions (either individual or group-based) and generic metformin treatment for preventing type 2 diabetes among high-risk individuals and (2) angiotensin-converting enzyme (ACE) inhibitors and beta-blockers for intensive hypertension control among type 2 diabetes patients. In the United States, additional interventions included annual diabetic retinopathy screening in persons with type 1 diabetes In the other developed regions they included ACE inhibitors, losartan and irbesartan treatment for preventing nephropathy among type 2 diabetes patients, becaplermin treatment for foot ulcer for type 1 or type 2 diabetes patients, intensive glycaemic control among type 2 diabetes patients targeting at an HbA1c level of 7% or less and simvastatin treatment for secondary prevention of cardiovascular disease (CVD) among type 2 diabetes patients with dyslipidaemia. Interventions with strong evidence to demonstrate that they were not cost-effective include; universal screening for undiagnosed type 2 diabetes and intensive glycaemic control targeting at fast plasma glucose at 108°mg°dl–1 in type 2 diabetic patients aged 55 years and older in the United States. In addition, there were a large number of interventions for which evidence on cost-effectiveness was weak. There were two interventions for which evidence on cost-effectiveness was mixed because of contradictory conclusions. Interventions with strong evidence to demonstrate that they were either cost-saving or cost-effective represent good use of heath care resources and should be adopted. These with strong evidence to demonstrate they were not cost-effective represent a poor use of heath care resources and should not be adopted. More research is needed on those interventions for which evidence of cost-effectiveness was weak or mixed
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.060 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.006 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".