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. 2016 Apr 9;16:17.
doi: 10.1186/s12902-016-0097-7.

Cost Effectiveness and Value of Information Analyses of Islet Cell Transplantation in the Management of 'Unstable' Type 1 Diabetes Mellitus

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Free PMC article

Cost Effectiveness and Value of Information Analyses of Islet Cell Transplantation in the Management of 'Unstable' Type 1 Diabetes Mellitus

Klemens Wallner et al. BMC Endocr Disord. .
Free PMC article

Abstract

Background: Islet cell transplantation is a method to stabilize type 1 diabetes patients with hypoglycemia unawareness and unstable blood glucose levels by reducing insulin dependency and protecting against severe hypoglycemia through restoring endogenous insulin secretion. This study analyses the current cost-effectiveness of this technology and estimates the value of further research to reduce uncertainty around cost-effectiveness.

Methods: We performed a cost-utility analysis using a Markov cohort model with a mean patient age of 49 to simulate costs and health outcomes over a life-time horizon. Our analysis used intensive insulin therapy (IIT) as comparator and took the provincial healthcare provider perspective. Cost and effectiveness data for up to four transplantations per patient came from the University of Alberta hospital. Costs are expressed in 2012 Canadian dollars and effectiveness in quality-adjusted life-years (QALYs) and life years. To characterize the uncertainty around expected outcomes, we carried out a probabilistic sensitivity analysis within the Bayesian decision-analytic framework. We performed a value-of-information analysis to identify priority areas for future research under various scenarios. We applied a structural sensitivity analysis to assess the dependence of outcomes on model characteristics.

Results: Compared to IIT, islet cell transplantation using non-generic (generic) immunosuppression had additional costs of $150,006 ($112,023) per additional QALY, an average gain of 3.3 life years, and a probability of being cost-effective of 0.5 % (28.3 %) at a willingness-to-pay threshold of $100,000 per QALY. At this threshold the non-generic technology has an expected value of perfect information (EVPI) of $260,744 for Alberta. This increases substantially in cost-reduction scenarios. The research areas with the highest partial EVPI are costs, followed by natural history, and effectiveness and safety.

Conclusions: Current transplantation technology provides substantial improvements in health outcomes over conventional therapy for highly selected patients with 'unstable' type 1 diabetes. However, it is much more costly and so is not cost-effective. The value of further research into the cost-effectiveness is dependent upon treatment costs. Further, we suggest the value of information should not only be derived from current data alone when knowing that this data will most likely change in the future.

Keywords: Beta cells; Cost-effectiveness analysis; Edmonton protocol; Intensive insulin therapy; Islet transplantation; Markov model; Scenario analysis; Type 1 diabetes; Value of information.

Figures

Fig. 1
Fig. 1
Summary model structure (simplified). The transplantation arm includes all six states. In contrast, the comparator arm only includes the Intensive Insulin Treatment states with and without diabetes-related complications and the Dead state
Fig. 2
Fig. 2
Cost-Effectiveness Acceptability Curves (CEACs). The probability of islet transplantation being cost-effective decreases with increasing discount rate and rises with WTP threshold levels. The CEACs are for scenarios with different discount rates: 0 % (doted line), 3 % (short-dashed line), 3.5 % (long-dashed line) and 5 % (solid line). The uncertainty spread around the mean cost-effectiveness increases (the curves becoming less steep) with increasing discount rates
Fig. 3
Fig. 3
Cost-Effectiveness Acceptability Frontiers (CEAFs). The CEAFs are for scenarios with different discount rates: 0 % (doted line), 3 % (short-dashed line), 3.5 % (long-dashed line) and 5 % (solid line). The dents in CEAFs, with their lowest points indicating the willingness-to-pay levels when islet transplantation becomes the net benefit maximizing alternative, move to higher WTP levels when using higher discount rates
Fig. 4
Fig. 4
Net Benefit Probability Map (NBPM). Our long-term results showed a higher than 90 % risk that the long-term net health benefit of islet transplantation is lower than minus 0.48 (mean = -0.97). For clarity the data was plotted in 2.5 year intervals
Fig. 5
Fig. 5
Expected value of perfect information (EVPI). The population EVPI for scenarios with different discount rates depicted as dotted (3 %), dashed (3.5 %) and solid (5 %) lines. With increasing discount rate the uncertainty spread is wider but the EVPI maximum is lower. Population-level factors were adjusted for different discount rates in scenarios

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References

    1. Ryan EA, Shandro T, Green K, Paty BW, Senior PA, Bigam D, et al. Assessment of the severity of hypoglycemia and glycemic lability in type 1 diabetic subjects undergoing islet transplantation. Diabetes. 2004; doi:10.2337/diabetes.53.4.955. - PubMed
    1. Senior PA, Kin T, Shapiro J, Koh A. Islet transplantation at the University of Alberta: Status update and review of progress over the last decade. Can J Diabetes. 2012; doi:10.1016/j.jcjd.2012.01.002. Elsevier Ltd.
    1. Jamiolkowski RM, Guo LY, Li YR, Shaffer SM, Naji A. Islet transplantation in type I diabetes mellitus. Yale J Biol Med. 2012;85:37–43. - PMC - PubMed
    1. Shapiro J, Lakey JRT, Ryan EA, Korbutt GS, Toth E, Warnock GL, et al. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med. 2000; doi:10.1056/NEJM200007273430401. - PubMed
    1. Steele C, Hagopian WA, Gitelman S, Masharani U, Cavaghan M, Rother KI, et al. Insulin secretion in type 1 diabetes. Diabetes. 2004;53:426–33. doi: 10.2337/diabetes.53.2.426. - DOI - PubMed

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