Abstract
Achieving optimal blood glucose control while avoiding hypoglycaemia forms the foundation of diabetes management. The objective of this study was to undertake a equilibrium analysis to identify the level of HbA1c reduction required to achieve the same quality of life benefit as achieved by avoiding events of non-severe symptomatic hypoglycemia (NSHE). This study used the IMS Core Diabetes Model (CDM), a validated and established diabetes model, to explore the relationship between the avoidance of NSHE, HbA1c reduction and quality-adjusted life expectancy (QALE). Scenario analysis (SA) comparing rates of NSHE ranging from 25 to 250 events per 100 patient years with no HbA1c effect (i) and comparing increasing difference in HbA1c change with no effect on NSHE (ii) were conducted. The model was run over a lifetime and benefits were discounted at 3.0%. Sensitivity analysis was conducted on the disutility of symptomatic hypoglycemia. The QALE gain associated with avoiding 1 NSHE per patient per year was 0.06; incremental QALE per event avoided changed in sensitivity analyses to 0.035, 0.124 and 0.212 quality adjusted life years for assumed disutilities of -0.0029, -0.0107 and -0.0184, respectively. The impact of HbA1c reduction on QALE gain ranged from 0.0112 to 0.1171 for changes between 0.1% and 1.0% points, respectively. The HbA1c reduction required to achieve equivalent QALE benefit as the avoidance of one NSHE per patient per year was 0.54% in the base case analysis (NSHE disutility of -0.0052) and 0.33%, 1.08% and 1.84% in SA for NSHE disutilities of 0.0029, -0.0107 and -0.0184, respectively. HbA1c change and reduced NSHE are key drivers of cost effectiveness. This analysis is noteworthy as it demonstrates the significant contribution to QALE associated with the avoidance of NSHE. The avoidance of NSHE is at least as powerful a driver of QALE as lowering HbA1c.
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