Cost-Effectiveness of Intensified Versus Conventional Multifactorial Intervention in Type

Appendix 1 Transition probabilities from Steno-2: intensive treatment arm

Year / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9+
Death / 0.00000 / 0.02500 / 0.01282 / 0.01299 / 0.01316 / 0.02685 / 0.04148 / 0.02878 / 0.02013
MI / 0.01250 / 0.01250 / 0.00000 / 0.03896 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00800
CABG / 0.00000 / 0.01250 / 0.01282 / 0.00000 / 0.01316 / 0.00000 / 0.01408 / 0.01429 / 0.00836
PCI / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000
Stroke (major) / 0.01250 / 0.01250 / 0.00000 / 0.00000 / 0.01316 / 0.00000 / 0.00000 / 0.00000 / 0.00477
Stroke (minor) / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000
Toe amp. / 0.00000 / 0.05000 / 0.01282 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00785
Major leg amp. / 0.00000 / 0.00000 / 0.02564 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00321
Revasc. leg / 0.00000 / 0.01250 / 0.01282 / 0.02597 / 0.00000 / 0.02667 / 0.00000 / 0.00000 / 0.00975
Revasc. carotid artery / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000
Hosp. for CHF / 0.00000 / 0.01250 / 0.00000 / 0.00000 / 0.03947 / 0.00000 / 0.00000 / 0.00000 / 0.00650
Dialysis / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000
ESRD / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000

MI = myocardial infarction; CABG = coronary artery bypass grafting; PCI = percutaneous coronary intervention; amp. = amputation; Revasc. = revascularization; Hosp. = hospitalization; CHF = congestive heart failure; ESRD = end-stage renal disease. Event rates were applied as observed in the Steno-2 study for years one to eight of the analysis, after which mean event rates were carried forward for subsequent years of simulation (and adjusted for age, see Appendix 3).

Appendix 2 Transition probabilities from Steno-2: conventional treatment arm

Year / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9+
Death / 0.00000 / 0.00000 / 0.02532 / 0.00000 / 0.05334 / 0.05696 / 0.04523 / 0.03175 / 0.02658
MI / 0.01266 / 0.01266 / 0.02532 / 0.02597 / 0.04018 / 0.08761 / 0.03030 / 0.00000 / 0.02934
CABG / 0.00000 / 0.00000 / 0.03797 / 0.00000 / 0.03983 / 0.02941 / 0.01515 / 0.00000 / 0.01530
PCI / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.01351 / 0.01408 / 0.00000 / 0.06351 / 0.01139
Stroke (major) / 0.06297 / 0.01266 / 0.03797 / 0.00000 / 0.00000 / 0.02941 / 0.00000 / 0.03175 / 0.02185
Stroke (minor) / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.02703 / 0.00000 / 0.00000 / 0.04688 / 0.00924
Toe amp. / 0.00000 / 0.00000 / 0.01266 / 0.02597 / 0.00000 / 0.00000 / 0.03030 / 0.07863 / 0.01845
Major leg amp. / 0.00000 / 0.00000 / 0.01266 / 0.01299 / 0.00000 / 0.00000 / 0.00000 / 0.01563 / 0.00516
Revasc. leg / 0.01266 / 0.01266 / 0.02532 / 0.01299 / 0.01351 / 0.01471 / 0.04478 / 0.01563 / 0.01903
Revasc. carotid artery / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.01471 / 0.00000 / 0.00000 / 0.00184
Hosp. for CHF / 0.00000 / 0.01899 / 0.03797 / 0.00000 / 0.01351 / 0.02879 / 0.12053 / 0.04738 / 0.03340
Dialysis / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.01351 / 0.00000 / 0.02985 / 0.00000 / 0.00542
ESRD / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.00000 / 0.01493 / 0.00000 / 0.00187

Appendix 3 Age-dependent risk adjustments

Event / Age-dependent adjustment factor / Reference
CHF / 1.044 / (12)
CVD event / 1.059 / Assumed same as for first MI (UKPDS 56) (13)
Revascularization of leg / 1.036 / Assumed same as for intermittent claudication (15)
Stroke / 1.092 / (UKPDS 60) (14)
Mortality / 1.08 / (11)

CHF = congestive heart failure; CVD event = cardiovascular event (myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting)

Appendix 4 Calculated disutility adjustments

/ Published State Disutility / Reference /
Uncomplicated type 2 diabetes / 0.814 / (16)
Complications
ESRD / -0.324 / (26)
CHF (hospitalization) / -0.181 / (16)
Myocardial infarction / -0.078 / (16)
Stroke (major and minor) / -0.115 / (27)
Interventions
Dialysis (acute)* / 0 / (26)
Revascularization of carotid artery† / 0 / (28)
PCI / 0 / (28)
CABG / 0 / (28)
Revascularization of leg† / 0 / (28)
Amputation (major) / -0.272 / (27)
Amputation (toe) / -0.204 / (29)

ESRD = end-stage renal disease; CHF = congestive heart failure; PCI = percutaneous coronary intervention; CABG = coronary artery bypass grafting; * = assumed only event disutility required as likely to be short-term; † = assumed to be same as PCI