PDB94 MARKOV AND MONTE-CARLO MODELS IN THE PROGRESSION OF DIABETES MELLITUS: A LITTERATURE REVIEW TO IDENTIIFY THE FACTORS INFLUENCING THE CHOICE OF THE TYPE OF MODEL

L Renard, I Borget
2010 Value in Health  
BACKGROUND: Advances in screening technology have led to rapid expansion of newborn screening as a public health initiative in the United States. Due to variation across states in program implementation, there is a lack of standardization and accountability, which can affect quality of care. Texas currently screens for 28 disorders. OBJECTIVES: The Texas Newborn Screening Performance Measures Project was initiated with the objective of developing evidence-based performance measures to improve
more » ... ality, accountability and uniformity in the care. METHODS: A three step approach was used for identifi cation and development of key measures for seven most critical disorders: systematic reviews; impact assessment; and feasibility assessment. Impact assessments (likert scale) were based on National Quality Measures Clearinghouse™ (NQMC) criteria: scientifi c soundness, relevance, health importance, impact on quality of care, and ability to address disparities in care. A likert scale was also used for feasibility assessment on key aspects: data availability, ease of collection, infrastructure and human resource needs, overall cost, and time constraints. RESULTS: A total of 50 performance measures were supported by scientifi c evidence. Impact and feasibility assessments led to the approval of 33/50 measures. "Time to initiate treatment" received the highest scores on potential impact on patient outcomes (mean impact score 86.67/100, SD 1.5). Other measures with potentially high impact (score >80/100) were: compliance with oral prophylactic medication and age at fi rst Prevnar® vaccination in sickle cell disease; screening of at-risk family members in fatty acid disorders; frequency of growth assessments in congenital adrenal hyperplasia and phenylalanine levels in phenylketonuria. "Time to treatment" for individual disorders was also ranked very high on feasibility (mean feasibility score 88.67/100, SD 3.88). CONCLUSIONS: This is one of the fi rst efforts to identify and develop evidence-based performance measures in newborn screening and can pave the way for system wide changes and development of national guidelines. OBJECTIVES: Investigate the type 2 diabetes mellitus (T2DM) treatment practice and achievement of therapeutic goals in a cohort of T2DM patients treated in the Brazilian PHCS. METHODS: This is a cross-sectional analysis of 383 T2DM outpatients treated in 5 cities covered by the PHCS. Data was collected using information from the previous year by interviewing patients using a validated questionnaire complemented by medical chart review. Therapeutic goals suggested by the Brazilian Diabetes Society were used as standard treatment. RESULTS: Mean age was 60.5 ± 9.6 years, mean BMI 29.1 ± 5.3 Kg/m2 and mean duration of diabetes of 12.2 ± 8.75 years. The frequency of associated arterial hypertension was 66.8% (n = 256); obesity 39% n = 144); dyslipidemia 69.6% (n = 267) and heart failure 5.5% (n = 21). Microvascular complications were present in 32.4% (n = 124); 8.1% (n = 31) had macrovascular complications; 18% (n = 69) had at least one micro and one macrovascular complication and 41.5% (n = 159) had no complications. Current treatment practice was: 3.6% (n = 14) diet only; 30% (n = 115) monotherapy with oral anti-diabetic (OAD); 37.8% (n = 145) combined therapy with more than one OAD agents; 23.2% (n = 89) combined therapy with insulin and 5.2% (n = 20) just insulin. The most prescribed drug was metformin (41.4%), followed by insulin (19.1%), sulphonylureas (18.6%), DPP4 inhibitors (8.7%), TZDs (5.5%), and others (6.7%). Medications for dyslipidemia was used by 47.5% (n = 178); cardiovascular drugs in 77.4% (n = 287) and antiobesity drugs in 4% (n = 15). Treatment targets were achieved in: 76.8% for systolic and diastolic blood pressure (<130 × 85 mmHg), 19.5% for BMI < 25 kg/m2, 28% for HDL cholesterol >55 women, 37.3% for HDL cholesterol >45 men and 28.2% reached the goal for HbA1c (within normal range). Only 6.8% of the group (n = 26) reached all the treatment targets. CONCLUSIONS: The national goals for glycemic control, blood pressure and lipid levels are rarely achieved in real-world clinical practice, even with the high use of medications. OBJECTIVES: Diabetes mellitus type 2 (T2DM) is a chronically progressive disease and the treatment must be selected according to the pathophysiological phase of the disease at the time the treatment is begun. The Croatian public diabetology sector takes care of approximately 150,000 adults treated with oral hypoglycemic agents (OHA) alone or in combination with insulin. Our objective was assessment of the clinical and economic consequences of OHA treatment in T2DM from a Croatian health care system perspective. METHODS: The target population defi ned for the study was diabetic patients treated with OHA alone. Medication consumption was quantifi ed by using Pharmis and CroDiab data. a clinical expert panel provided resource-use information not available in published literature or health care databases. RESULTS: Current consumption data is showing that 62.8% patients are using OHA as monotherapy. Within this group, majority is using either biguanides or sulphonylureas. Patients treated with sulphonylureas are represented with almost the same percentage as those treated with biguanides (25% vs. 29%). Combination of two OHA is used in 34.2% while 3% of patients are treated by triple therapy. The most often choice in dual therapy is combination of biguanides and sulphonylureas while biguanides, sulphonylureas and thiazolidinediones in combination as the most favourable treatment option in triple therapy. Biguanides are used as a one of OHA in 61% of patients. CONCLUSIONS: Considering current clinical guidelines, lifetime benefi ts of biguanides and facts that they are low-cost agent, relatively small proportion of T2DM patients are treated with this agent in Croatia. Findings of this investigation revealed real life pattern of T2DM treatment, which enables directing in better treating and more cost-effective management in Croatia. OBJECTIVES: Using a large, US administrative pharmacy claims database, calculate proportion of days covered (PDC) using actual days supply, and compare estimated PDC (ePDC) using days supply derived from drug-specifi c Defi ned Daily Dose (DDD) criteria. METHODS: Continuously eligible patients fi lling non-insulin anti-diabetic medication were targeted from a large sample of pharmacy claims during 2008 and 2009. Medications were grouped into ATC diabetes drug classes. Proportion of days covered (PDC) was calculated as the number of days a patient had medication in their possession divided by the number of days in the period. PDC was fi rst calculated using actual days supply, then ePDC was calculated using an estimated days supply from DDD, strength, and pill quantity. The percent of patients adherent to therapy was defi ned by a PDC > 0.80. The reliability of each method was assessed by Pearson correlation coeffi cients and agreement above chance was assessed using Kappa statistics. RESULTS: Adherence was calculated for 163,750 patients taking non-insulin anti-diabetics. Overall, the PDC was 0.69 and ePDC 0.57. The two measures were also highly and signifi cantly correlated (r = 0.73; P < 0.0001). The percent adherent was 48.8% (PDC) and 34.4% (ePDC), (Kappa = 0.50; P < 0.0001). At the medication class level, differences in PDC and ePDC ranged from 0.01 to 0.35, with correlation coeffi cients ranging from 0.40 to 0.93. Differences in the percent adherent metric ranged from −2.3 to 23.2, and kappa values from 0.22 to 0.89. CONCLUSIONS: Applying DDD estimates for the purposes of diabetes adherence estimation when lacking days supply values may provide reasonable estimates of adherence based on results presented here. At the medication class level there is greater variability in the reliability measures. Including claims from the U.S. only is a limitation of this analysis, as local treatment patterns may vary, and DDD values were not available for all U.S. medications. OBJECTIVES: Markov and Monte-Carlo (MC) models are often used to simulate Diabetes Mellitus (DM) and its complications over time, but reasons to choose the model type are poorly documented. a systematic literature review was performed to identify factors infl uencing the choice of the model type. METHODS: Models simulating the progression of DM and its complications were selected from Medline and Embase databases. Literature reviews, methodological articles and non original models were excluded. Each full-paper selected went through a 31-item checklist via a doublereading process. a qualitative analysis was performed to evaluate the accuracy of the model with the study question. RESULTS: Sixty-one models were selected, including
doi:10.1016/s1098-3015(11)72152-0 fatcat:ruta7m7lrremrpyzd57i6l7pxu