PDB42 COST-EFFECTIVENESS ANALYSIS FOR HBA1C TEST INTERVALS IN PATIENTS ON TREATMENT FOR STABLE TYPE 2 DIABETES

Abstract

To determine the optimal HbA1c test interval strategy among type 2 diabetes mellitus (T2DM) patients with stable glycemic control. Markov model was built to study the optimal glycemic monitoring among T2DM patients with stable glycemic control. In the Markov model, different HbA1c test intervals were compared to evaluate costs per quality-adjusted life year (QALY) and the incremental cost-effectiveness ratio (ICER). We compared every 3 months intervals (current Japanese strategy), every six months (US and UK recommendations) and annual monitoring, focusing on HbA1c test characteristics of signal (true change) and noise (error), which were reported in the previous study. All model parameters including screening and treatment costs, complication and mortality rates and utilities were also drawn from published studies. The willingness-to-pay threshold in cost-effectiveness analysis was set to US $50,000/QALY. Based on our analysis, annual interval was most cost-effective to monitor T2DM patients with stable glycemic control. Three months interval was dominated. ICER for annual interval was $463.39/QALY compared to 6 months interval. Once patients achieve stable glycemic control at their HbA1c goal, an informative interval for HbA1c monitoring is once every year. Current guidelines, which suggest testing every six months, may contribute to substantial over-testing.