PHARMACY

New research examines cost-effectiveness of lowering HbA1C cutoff

BY Allison Cerra

NEW YORK — Reducing the cutoff of hemoglobin A1C to determine if a patient has prediabetes could be cost effective, according to a new study.

The American Diabetes Association recommends HbA1C testing as one basis for identifying diabetes and prediabetes and has established the HbA1C value of 6.5% as the diagnostic cutoff. Researchers — led by Xiaohui Zhuo of the Division of Diabetes Translation at the National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention — sought to determine "the cost effectiveness associated with the alternative HbA1C cutoffs for identifying prediabetes." The researchers created a simulation sample from data of nondiabetic American adults, ages 18 years and older, from the National Health and Nutritional Examination Survey (1999-2006).

Lowering the HbA1C cutoff would increase the health benefits of the preventive interventions at higher costs:

  • For high-cost intervention, lowering the HbA1C cutoff from 6% to 5.9% and from 5.9% to 5.8% would result in $27,000 and $34,000 per quality-adjusted life-year gained, respectively;

  • Decreasing 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 low-cost intervention, lowering the HbA1C cutoff from 6% to 5.9% and from 5.9% to 5.8% would result in $24,000 and $27,000 per QALY gained, respectively;

  • Lowering 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.

"Establishing an HbA1C cutoff for prediabetes … has been more challenging than for diabetes because the relationship between the incidence of Type 2 diabetes and HbA1C below 6.5% is continuous, with no clearly demarcated threshold that is associated with an accelerated risk of diabetes or other morbidities," the study authors said. "It was found that lowering the HbA1C cutoff resulted in greater health benefıts, but also led to an increase in costs and, consequently, a decrease in the economic effıciency of preventive interventions. As a result, from a healthcare system perspective, determination of an optimal HbA1C cutoff ultimately depends on the level of effıciency that society can accept, or more specifıcally, the resources it is willing to make available for Type 2 diabetes prevention."


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PHARMACY

Late-stage trial of MS drug shows positive results

BY Alaric DeArment

JERUSALEM — A drug under investigation by Teva Pharmaceutical Industries and Active Biotech reduced symptoms and progression of disease in patients with multiple sclerosis, according to results of a late-stage clinical trial.

Teva and Active announced the publication of results of the phase-3 "Allegro" study of oral laquinimod in the March 15 issue of the New England Journal of Medicine. The study was conducted in 24 countries and enrolled 1,106 patients with MS who received 0.6 mg of laquinimod per day or placebo.

Data from the study showed that the drug, taken once per day, reduced inflammatory disease, slowed disability progression and decreased loss of brain tissue, but was overall safe for patients with MS.

"The publication of the Allegro results in a prestigious peer-reviewed journal is an important landmark as we continue to research and develop laquinimod," stated Teva Global Branded Products SVP research and development Lesley Russell. "We look forward to continuing to work with regulatory authorities in both the E.U. and the U.S. to bring this novel therapy to the MS community."


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NACDS Foundation seeks nominations for inaugural faculty scholars program

BY Antoinette Alexander

ALEXANDRIA, Va. — The National Association of Chain Drug Stores Foundation has launched a new program designed to annually educate assistant professors from U.S. schools and colleges of pharmacy about designing, implementing and publishing community pharmacy-based patient care research.

The NACDS Foundation Faculty Scholars Program will provide participants with advanced educational opportunities through in-person meetings, regular conference calls, individualized mentoring, Web-based lecture material and online discussion forums. Participating professors will obtain one-to-one coaching and support from experienced researchers at the University of Pittsburgh, and research grants to launch patient-centered care projects.

“The NACDS Foundation’s Faculty Scholars Program will help catalyze innovative research to explore community pharmacists’ role in impacting health outcomes and reducing costs through medication counseling and other health services,” stated NACDS Foundation president Kathleen Jaeger. “We are thrilled to foster research by young academics and provide them with a wealth of resources, including the opportunity to obtain expert advice from experienced researchers and engage in peer-to-peer review.”

The NACDS Foundation will accept five scholars for the inaugural 2012-2013 class. The first in-person meeting of the selected faculty members will be held during the NACDS Pharmacy & Technology Conference, to be held August 25 to 28 in Denver.

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