Towards Health Economic Simulation Model of Type 2 Diabetes in Sweden
Health economists use a variety of computer models (known as health economic simulation models [HESMs]) to assist decision-making in different medical fields including diabetes.These are used as a tool to estimate the different outcomes of healthcare interventions, especially in chronic diseases where the disease and its treatments have long-term effects on patients'life. These models are particularly useful when a decision problem involves a risk that is ongoing over time.
The prevalence of type 2 diabetes is growing worldwide. It is associated with increased risk of some macro and microvascular complications. These associations not only have a negative impact on patients' life expectancy and quality of life, but also impose substantial economic burden on families, health systems and societies. Therefore, type 2 diabetes is considered as a significant challenge for health policy-makersin many countries and a number of HESMs were developed and applied to assist informed decisions to allocate scarce health resources to diabetes interventions and programs.Diabetes-related HESMs generally constitutes of three main modules: progression of risk factors over time, risk of experiencing diabetes-related complications, and effects of complications on patients' health-related quality of life (to calculate quality-adjusted life years).
While these HESMs are applicable by health policy-makers in different countries, transitional nature of medical context,andclinical, environmental and organizational disparities across countries, and limitations of current HESMs suggest that updating them whenever new data is available is an ongoing task. In Sweden, initiation of the national diabetes register (NDR) provides required data to update current HESMs or develop a new HESM for Sweden. Individual-level demographic and clinical data on adults aged ≥18 years who have provided informed consent to participate are reported to the NDR by trained nurses or physicians in all hospital diabetes outpatient clinics and primary health care centres at least once a year. In the current study, updating each module of a HESM form a sub-study (three studies in total) and then in fourth sub-study, these updated modules are applied in a model to evaluate cost-effectiveness of two interventions in type 2 diabetes context. Therefore, following four sub-studies are included in the thesis:
1.Estimation the time path of major cardiovascular risk factors in patients with type 2 diabetes.
2.Estimation the risk of first and second major cardiovascular events in patients with type 2 diabetes.
3. Estimating and exploring health utilities of type 2 diabetes-related complications
4.Cost-utility analysis of two type 2 diabetes-related interventions using a modelling approach