Background
Diabetes
Markov models and diabetes prevention
Objective
Methods
The model
Input parameters
Transition probabilities
Characteristic | Options | Description |
---|---|---|
Sex | Male | |
Female | ||
Age | Metric | |
Education | High | University or education >12 years education |
Middle | 10–12 years of education | |
Low | Compulsory school or <10 years of education | |
Triglyceride | Normal | <1.7 mmol/l |
High | ≥1.7 mmol/l | |
Blood pressure | Normal | Systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg AND no self-reported anti-hypertensive drug |
High | Self-reported anti-hypertensive drug OR systolic blood pressure ≥140 mmHg OR diastolic blood pressure ≥90 mmHg | |
BMI | Underweight | <18.5 kg/m2
|
Normal | 18.5–24.9 kg/m2
| |
Overweight | 25–29.9 kg/m2
| |
Obese | ≥30 kg/m2
| |
Smoking | Never Formerly Present | |
Physical activity | Physically active | Exercise at least 2–3 times/week or walk and/or cycle more than 3 times/week during leisure time or walk or cycle to work more than 5 km per way |
Moderately active | Exercise now and then but not regularly or cycle and/or walk during their leisure time at least 2–3 times per week or cycle and/or walk to work 2–5 km each way | |
Sedentary | Never exercise or walk and/or cycle during their leisure time less than 2–3 times per week or take bus or car to work or cycle and/or walk to work less than 2 km per way. | |
Current snus use | No | Snus is an oral non-smoking tobacco that is commonly used in Sweden. It is put into the mouth, usually underneath the upper lip. |
≤4 cans per week | ||
>4 cans per week | ||
Nutrition | At least 5 a day | At least five portions of fruits/vegetables per day |
Less than 5 a day | Less than five portions of fruits/vegetables per day | |
Marital status | Partnership | Married or living with spouse |
Single | Not married or widowed or divorced | |
Family history of T2D | Yes | Parents or siblings with T2D |
No | No parents or sibling with T2D | |
Self-perceived health | Good | Very good, pretty good, somewhat good |
Bad | Pretty bad, bad |
From state A to state B | Regression model |
---|---|
NGT to IFG | Logit P(NGT to IFG) = –3.07 to 0.29 * sex + 0.01 * age + 0.11 * education + 0.19 * family history of T2D –0.09 * current snus use + 0.15 * triglyceride + 0.12 * blood pressure + 0.16 * BMI + 0.23 * smoking |
NGT to IGT | Logit P(NGT to IGT) = –7.29 + 0.51 * sex + 0.06 * age + 0.09 * education + 0.14 * physical activity + 0.15 * family history of T2D + 0.41 * triglyceride + 0.34 * blood pressure + 0.21 * BMI –0.12 * smoking |
NGT to IFG and IGT | Logit P(NGT to IFG and IGT) = –6.20 to 0.16 * sex + 0.04 * age –0.24 * current snus use + 0.32 * family history of T2D + 0.15 * physical activity + 0.20 * triglyceride + 0.60 * blood pressure + 0.50 * BMI –0.33 * nutrition |
IFG to NGT | Logit P(IFG to NGT) = = 2.84–0.43 * family history of T2D –0.02 * age –0.23 education –0.25 * blood pressure –0.38 * BMI –0.26 * triglyceride |
IGT to NGT | Logit P(IGT to NGT) = 3.06 + 0.72 * sex –0.07 * age –0.23 * education –0.37 * BMI –0.29 * self-perceived health –0.49 * triglyceride |
IFG and IGT to NGT | Logit P(IFG and IGT to NGT) = –0.61 + 0.81 * sex + 1.15 * current snus use –1.24 * smoking 1 –0.77 * BMI |
IFG to T2D | Logit P(IFG to T2D) = –6.98 to 0.44 * sex + 0.05 * age + 0.48 * family history of T2D + 0.36 * marital status + 0.51 * nutrition + 0.30 * triglyceride + 0.61 * blood pressure + 0.57 * BMI |
IGT to T2D | Logit P(IGT to T2D) = –6.54 to 0.75 * sex + 0.07 * age + 0.87 * nutrition + 0.35 * BMI + 0.35 * blood pressure + 0.56 * triglyceride |
IFG and IGT to T2D | Logit P(IFG and IGT to T2D) = - 0.55 - 0.61 * sex + 0.71 * BMI + 0.87 * family history of T2D - 1.06 * nutrition + 0.42 * smoking |
T2D to IFG | Logit P(T2D to IFG) = –0.34 to 0.57* BMI - 0.68 * blood pressure –0.385 * smoking |
T2D to IGT | Logit P(T2D to IGT) = –3.37 to 1.42 * family history of T2D + 1.13 self-perceived health |
T2D to IFG and GT | Logit P(T2D to IFG and IGT) = –6.80 + 1.22 * sex + 1.49 * physical activity + 0.63 * education –1.07 * self-perceived health |
Characteristic | No intervention [22] | Intervention |
---|---|---|
Sex | Male | Male |
Female | Female | |
Age | 30 | 30 |
50 | 50 | |
70 | 70 | |
Education (%) | ||
High | 25.5 | As no intervention |
Middle | 53.8 | |
Low | 20.7 | |
Triglyceride (%) | ||
Normal | 71.2 | As no intervention |
High | 28.8 | |
Blood pressure (%) | ||
Normal | 65.0 | As no intervention |
High | 35.0 | |
BMI (%) | ||
Underweight | 0.5 | 0.5 |
Normal | 38.8 | 41.0a
|
Overweight | 43.9 | 42.6b
|
Obese | 16.8 | 16.0c
|
Smoking (%) | ||
Never | 43.4 | As no intervention |
Formerly | 31.1 | |
Present | 25.5 | |
Physical activity (%) | ||
Active | 9.7 | 18.6 |
Moderately | 68.4 | 62.4 |
Sedentary | 25.9 | 19.0 |
Current snus use (%) | ||
No | 87.6 | As no intervention |
≤4 cans/week | 9.3 | |
>4 cans/week | 3.1 | |
Nutrition (%) | ||
At least | 9.2 | 18.3 |
Less than | 90.8 | 81.7 |
Marital status (%) | ||
Married | 84.1 | As no intervention |
Single | 15.9 | |
Family history of T2D (%) | ||
No | 77.4 | As no intervention |
Yes | 22.6 | |
Self-perceived health (%) | ||
Good | 73.8 | As no intervention |
Bad | 26.2 |
Mortality
Utilities
HUW | No intervention | Intervention | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Sex/age | NGT | IFG | IGT | IFG and IGT | T2D | NGT | IFG | IGT | IFG and IGT | T2D | |
Male/30 | 0.83 | 0.82 | 0.73 | 0.77 | 0.72 | 0.83 | 0.82 | 0.73 | 0.77 | 0.72 | |
Male/50 | 0.83 | 0.82 | 0.72 | 0.79 | 0.72 | 0.83 | 0.82 | 0.72 | 0.79 | 0.72 | |
Male/70 | 0.83 | 0.81 | 0.72 | 0.81 | 0.72 | 0.83 | 0.82 | 0.72 | 0.81 | 0.72 | |
Female/30 | 0.80 | 0.79 | 0.70 | 0.74 | 0.68 | 0.80 | 0.79 | 0.70 | 0.74 | 0.68 | |
Female/50 | 0.80 | 0.79 | 0.70 | 0.76 | 0.68 | 0.80 | 0.79 | 0.70 | 0.76 | 0.68 | |
Female/70 | 0.80 | 0.78 | 0.69 | 0.78 | 0.68 | 0.80 | 0.78 | 0.69 | 0.78 | 0.68 |
Costs
State | Cost (euros) | Source |
---|---|---|
NGT | 0.00 | |
IFG | 3853.30 | |
IGT | 3853.30 | |
IFG and IGT | 3853.30 | |
T2D | 8376.74 | direct (3602.00 €) + indirect (4774.74 €) costs |
Direct costs | 3602.00 | Mean direct costs of T2D per patient, year 2004, year 2007, euros, including: inpatient care, outpatient hospital care; outpatient primary care, antidiabetic drugs, antihypertensive drugs, lipid-lowering drugs, devices; SD: 9537 € [33] |
Indirect costs | 4774.74 | 57% of total T2D cost; including: sickness absence, early retirement, production loss due to mortality [34] |
Intervention cost
Analyses
Distribution of probability parameters for probabilistic analysis
Sensitivity analyses
Results
Deterministic analyses
Male | Female | |||||
---|---|---|---|---|---|---|
Cost | QALY | ICER | Cost | QALY | ICER | |
Age 30 | ||||||
No intervention | 53,915 | 19.9 | 46,037 | 20.1 | ||
Intervention | 56,383 | 20.5 | 4109 | 48,355 | 20.7 | 3833 |
Age 50 | ||||||
No intervention | 65,013 | 14.5 | 59,742 | 15.2 | ||
Intervention | 67,690 | 14.9 | 6088 | 62,341 | 15.6 | 5656 |
Age 70 | ||||||
No intervention | 44,721 | 7.5 | 47,739 | 8.3 | ||
Intervention | 46,819 | 7.7 | 9215 | 49,957 | 8.6 | 8728 |
Probabilistic analyses
Male | Female | |||||
---|---|---|---|---|---|---|
Δ Cost | Δ QALY | ICER | Δ Cost | Δ QALY | ICER | |
Age 30 | ||||||
Mean | 3228 | 0.60 | 5 402 | 2117 | 0.61 | 3455 |
Median | 2592 | 0.59 | 1783 | 0.61 | ||
Percentile interval | –33,852; 41,414 | 0.27; 0.97 | –30,122; 34,400 | 0.29; 0.97 | ||
Age 50 | ||||||
Mean | 2983 | 0.43 | 6 885 | 2065 | 0.45 | 4552 |
Median | 2392 | 0.43 | 1962 | 0.45 | ||
Percentile interval | –35,499; 37,372 | 0.16; 0.76 | –30,525; 37,260 | 0.12; 0.81 | ||
Age 70 | ||||||
Mean | 2138 | 0.22 | 9 505 | 2192 | 0.25 | 8771 |
Median | 1866 | 0.22 | 1 995 | 0.25 | ||
Percentile interval | –11,322; 17,653 | 0.12; 0.35 | –12,624; 19,436 | 0.13; 0.40 |