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A Systematic Review of Methodologies Used in Models of the Treatment of Diabetes Mellitus

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Abstract

Background

Diabetes mellitus is a chronic and complex disease, increasing in prevalence and consequent health expenditure. Cost-effectiveness models with long time horizons are commonly used to perform economic evaluations of diabetes’ treatments. As such, prediction accuracy and structural uncertainty are important features in cost-effectiveness models of chronic conditions.

Objectives

The aim of this systematic review is to identify and review published cost-effectiveness models of diabetes treatments developed between 2011 and 2022 regarding their methodological characteristics. Further, it also appraises the quality of the methods used, and discusses opportunities for further methodological research.

Methods

A systematic literature review was conducted in MEDLINE and Embase to identify peer-reviewed papers reporting cost-effectiveness models of diabetes treatments, with time horizons of more than 5 years, published in English between 1 January 2011 and 31 of December 2022. Screening, full-text inclusion, data extraction, quality assessment and data synthesis using narrative synthesis were performed. The Philips checklist was used for quality assessment of the included studies. The study was registered in PROSPERO (CRD42021248999).

Results

The literature search identified 30 studies presenting 29 unique cost-effectiveness models of type 1 and/or type 2 diabetes treatments. The review identified 26 type 2 diabetes mellitus (T2DM) models, 3 type 1 DM (T1DM) models and one model for both types of diabetes. Fifteen models were patient-level models, whereas 14 were at cohort level. Parameter uncertainty was assessed thoroughly in most of the models, whereas structural uncertainty was seldom addressed. All the models where validation was conducted performed well. The methodological quality of the models with respect to structure was high, whereas with respect to data modelling it was moderate.

Conclusions

Models developed in the past 12 years for health economic evaluations of diabetes treatments are of high-quality and make use of advanced methods. However, further developments are needed to improve the statistical modelling component of cost-effectiveness models and to provide better assessment of structural uncertainty.

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Acknowledgements

We would like to thank the Editor and two anonymous reviewers for their comments that have much contributed to improve the final version of this paper.

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Authors and Affiliations

  1. Division of Health Research, Lancaster University, Bailrigg, Lancaster, UK

    Marina Antoniou, Céu Mateus & Bruce Hollingsworth

  2. Department of Mathematics and Statistics, Lancaster University, Bailrigg, Lancaster, UK

    Andrew Titman

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  1. Marina Antoniou
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Correspondence to Marina Antoniou.

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Authors’ Contributions

MA: conceptualisation and design, literature search and selection, quality assessment of included studies, data extraction, statistical analysis and interpretation of data, drafted and reviewed the manuscript. CM: conceptualisation and design, reviewed the data, drafted and reviewed the manuscript. BH: conceptualisation and design, reviewed and revised the manuscript. AT: reviewed the data generated, reviewed and revised the manuscript.

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This research received no specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Antoniou, M., Mateus, C., Hollingsworth, B. et al. A Systematic Review of Methodologies Used in Models of the Treatment of Diabetes Mellitus. PharmacoEconomics 42, 19–40 (2024). https://doi.org/10.1007/s40273-023-01312-4

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