title: A simulation model for estimating direct costs of type 1 diabetes prevention.
abstract: BACKGROUND
  The ongoing Type 1 Diabetes Prediction and Prevention Project in Finland (DIPP) is based on screening of genetic type 1 diabetes mellitus susceptibility, subsequent autoantibody follow-up and experimental preventive treatment with nasal insulin.
  
  
  OBJECTIVE
  To analyse direct costs of type 1 diabetes prevention therapy with nasal insulin as it is now being studied in the DIPP project, and as it might be used as a part of routine healthcare in Finland.
  
  
  METHODS
  For the purposes of cost analysis, two different diabetes prevention models were constructed. The research-oriented model followed accurately the DIPP protocol and the practice-oriented model was based on the estimates of a panel of experts on how the prevention would be conducted as a part of the routine healthcare in Finland. To take into account the uncertainty and variability attached to the use of resources, a Monte Carlo simulation model was utilised. The costs of the two models comprising 500 iterations each were simulated using the Monte Carlo model.
  
  
  METHODS
  This study was performed from the healthcare provider's viewpoint.
  
  
  RESULTS
  The total direct costs per person of the research-oriented model were 2102 and 1676 euros (EUR) in the first and second year and those of the practice-oriented model EUR827 and EUR675, respectively (EUR1 approximately dollars US1.1; 2002 values). Subsequently, the costs rose only as a result of the increased use of insulin as the children grew older. After the 15th year, when the age structure of the population in the study had stabilised, the annual direct costs per person were EUR1798 (research-oriented model) and EUR797 (practice-oriented model).
  
  
  CONCLUSIONS
  The costs of prevention with nasal insulin are low when compared with estimates of the annual healthcare costs of type 1 diabetes. This study suggests, with some critical assumptions (in particular, that nasal insulin is effective in the prevention of type I diabetes), that a 2 to 3-year delay in the disease onset may make prevention according to the practice-oriented model cost saving.
authors.affiliation: Department of Economics, Turku School of Economics and Business Administration, Turku, Finland. jarmo.hahl@gsk.com
authors.forename: Jarmo
authors.initials: J
authors.lastname: Hahl
authors.forename: Tuula
authors.initials: T
authors.lastname: Simell
authors.forename: Antti
authors.initials: A
authors.lastname: Kupila
authors.forename: Päivi
authors.initials: P
authors.lastname: Keskinen
authors.forename: Mikael
authors.initials: M
authors.lastname: Knip
authors.forename: Jorma
authors.initials: J
authors.lastname: Ilonen
authors.forename: Olli
authors.initials: O
authors.lastname: Simell
mesh_terms: D000281:Administration, Intranasal; D003198:Computer Simulation; D003922:Diabetes Mellitus, Type 1 / Q000191:economics* / Q000517:prevention & control*; D005387:Finland; D005500:Follow-Up Studies; D005544:Forecasting; D005102:Health Expenditures; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D018803:Models, Economic; D009010:Monte Carlo Method
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin