Alternative HbA1c Cutoffs to Identify High-Risk Adults for Diabetes Prevention A Cost-Effectiveness Perspective
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Diabetes
Alternative HbA1c Cutoffs to Identify High-Risk Adults for Diabetes Prevention A Cost-Effectiveness Perspective
Discuss any aspect of type I or type II diabetes mellitus here
There is considerable disagreement as to the A1C cutoff for pre-diabetes with a wide range of A1Cs suggested by different guidelines. Zhuo and his colleagues at CDC have looked at various A1C c
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Forums » Open clinical » Diabetes » Alternative HbA1c Cutoffs to Identify High-Risk Adults for Diabetes Prevention A Cost-Effectiveness Perspective
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Alternative HbA1c Cutoffs to Identify High-Risk Adults for Diabetes Prevention A Cost-Effectiveness Perspective
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Alternative HbA1c Cutoffs to Identify High-Risk Adults for Diabetes Prevention A Cost-Effectiveness Perspective
posted at 14/3/2012 4:21 PM GMT
on bmj.com
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Posts: 453
First: 29/4/2011 Last: 14/5/2013 |
There is considerable disagreement as to the A1C cutoff for pre-diabetes with a wide range of A1Cs suggested by different guidelines. Zhuo and his colleagues at CDC have looked at various A1C cutoff values as a function of health benefits and treatment costs. They conclude that A1C cusoffs as lowat 5.7% are cost-effective. Zhuo X, et al "Alternative HbA1c cutoffs to identify high-risk adults for diabetes prevention: a cost-effectiveness perspective" Am J Prev Med 2012; DOI: 10.1016/j.amepre.2012.01.003.ABSTRACT Background: New recommendations about the use of hemoglobin A1c (HbA1c) for diagnosing diabetes have stimulated a debate about the optimal HbA1c cutoff to identify prediabetes for preventive intervention. Purpose: To assess the cost effectiveness associated with the alternative HbA1c cutoffs for identifying prediabetes. Methods: A Markov simulation model was used to examine the cost effectiveness associated with a progressive 0.1% decrease in the HbA1c cutoff from 6.4% to 5.5%. The target population was the U.S. nondiabetic population aged 18 years. The simulation sample was created using the data of nondiabetic American adults from the National Health and Nutritional Examination Survey (NHANES 1999–2006). People identifıed as having prediabetes were assumed to receive a preventive intervention, with effectiveness the same as that in the Diabetes Prevention Program study under a high-cost intervention (HCI) scenario and in the Promoting a Lifestyle of Activity and Nutrition for Working to Alter the Risk of Diabetes study under a low-cost intervention (LCI) scenario. The analysis was conducted for a lifetime horizon from a healthcare system perspective. Results: Lowering the HbA1c cutoff would increase the health benefıts of the preventive interventions at higher costs. For the HCI, lowering the HbA1c cutoff from 6.0% to 5.9% and from 5.9% to 5.8% would result in $27,000 and $34,000 per QALY gained, respectively. Continuing to decrease the cutoff from 5.8% to 5.7%, from 5.7% to 5.6%, and from 5.6% to 5.5% would cost $45,000, $58,000, and $96,000 per QALY gained, respectively. For the LCI, lowering the HbA1c cutoff from 6.0% to 5.9% and from 5.9% to 5.8% would result in $24,000 and $27,000 per QALY gained, respectively. Continuing to lower the cutoff from 5.8% to 5.7%, 5.7% to 5.6%, and 5.6% to 5.5% would cost $34,000, $43,000 and $70,000 per QALY gained, respectively. Conclusions: Lowering the HbA1c cutoff for prediabetes leads to less cost-effective preventive interventions. Assuming a conventional $50,000/QALY cost-effectiveness benchmark, the HbA1c cutoffs of 5.7% and higher were found to be cost effective. Lowering the cutoff from 5.7% to 5.6% also may be cost effective, however, if the costs of preventive interventions were to be lowered COMMENT: Dichotomizing a continuous variable is always dicey. The trouble with these sorts of analyses is that A1C is just one risk factor and I find it hard to see what changes in recommendations that I would make at an A1C of 5.7% to 6.4% that I would not make absent knowledge of the A1C: lose weight if the BMI is >25, increase physical activity, diagnose and treat other cardiovascular risk factors, hypertension and abnormal lipids. I guess what the knowledge of A1C adds is the probability of developing type 2 diabetes as the higher the A1C in the "normal" range the more likely is the development of type 2 diabetes. in terms of adding metformin, the data on the benefit of adding metformin when lifestyle chages are not successful is based upon glucose values, not A1C. I am curious as to what you use to diagnose pre-diabetes glucose or A1C, what values you use and your use of metformin in pre-diabetes.
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Forums » Open clinical » Diabetes » Alternative HbA1c Cutoffs to Identify High-Risk Adults for Diabetes Prevention A Cost-Effectiveness Perspective
