Analytical approach:
The analysis was based on the validated UK Prospective Diabetes Study (UKPDS) Outcomes Model, which evaluated the risk of seven diabetes-related complications over a lifetime. The authors stated that the perspective of the Canadian health system was adopted.
Effectiveness data:
The patient demographic and clinical data were identified by a systematic review of published randomised controlled trials (RCTs) and observational studies. The methods of this review were reported elsewhere (Canadian Agency for Drugs and Technologies in Health, 2009, see 'Other Publications of Related Interest' below for bibliographic details). The clinical outcomes for the review were glycated haemoglobin (HbA
1c), hypoglycaemia, quality of life, the long-term complications of diabetes, and mortality.
Monetary benefit and utility valuations:
The utility values were from a US catalogue of European Quality of life (EQ-5D) questionnaire scores.
Measure of benefit:
Quality-adjusted life-years (QALYs) and life-years were the summary benefit measures, and they were discounted at an annual rate of 5%.
Cost data:
The economic analysis included the cost of the blood glucose test strips and the treatment of diabetes-related complications, including myocardial infarction, ischaemic artery disease, heart failure, stroke, amputation, blindness, and end-stage renal disease. The costs of self-monitoring were based on a daily use of 1.29 test strips. The costs and quantities of complications were from the Ontario Ministry of Health and Long-term Care and included in-patient, out-patient and emergency department visits, prescription drug claims, long-term care, and home care. All costs were in Canadian dollars (CAD) for the year 2008 and a 5% annual discount rate was applied.
Analysis of uncertainty:
Deterministic sensitivity analyses were undertaken on several model inputs including the cost of the test strips, the testing frequency, the baseline HbA
1c levels, the patient characteristics, and the utility decrement for symptomatic hypoglycaemia. Cost-effectiveness acceptability curves were created for various willingness-to-pay thresholds.