title: Modeling the efficiency of reaching a target intermediate end point: a case study in type 2 diabetes in the United States.
abstract: OBJECTIVE
  The objective of this study was to describe an approach to modeling the efficiency of an intervention by focusing on an established intermediate end point directly. A case study addresses the economic efficiency of obtaining dual glycemic control over time, according to initial choice of treatment.
  
  
  METHODS
  From the perspective of a payer in the United States, instead of the usual approach of basing the model on projecting long-term diabetic complications from glycemic control, this model focuses directly on glycemic control. Treatment changes and associated health-care utilization needed to address postprandial glucose. After assigning each of 10000 drug-naïve patients, HbA1c, age, race, and sex based on distributions from a randomized clinical trial, the model applies the efficacy of nateglinide compared to metformin. Sensitivity analyses were carried out for all parameters. Costs are reported in year 2000 US dollars and discounted at 3%.
  
  
  RESULTS
  In the base case, starting on nateglinide and increasing the time in dual glycemic control over 3 years by 2.4 months led to savings of US dollars 295 compared to starting on metformin. Savings increased with stricter treatment criteria but decreased if glycemic control was better initially.
  
  
  CONCLUSIONS
  This study illustrates the use of an efficiency model that focuses directly on the relevant short-term end point: glycemic control. Starting patients with nateglinide is shown to be an efficient way of obtaining dual glycemic control during the first 3 years of treatment.
authors.affiliation: Caro Research Institute, Concord, MA, USA. jcaro@caroresearch.com
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Caro
authors.forename: Maribel
authors.initials: M
authors.lastname: Salas
authors.forename: Judith A
authors.initials: JA
authors.lastname: O'Brien
authors.forename: Khajak
authors.initials: K
authors.lastname: Ishak
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sung
authors.forename: Gabriel
authors.initials: G
authors.lastname: Raggio
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects; D003362:Cost-Benefit Analysis / Q000379:methods; D003510:Cyclohexanes / Q000191:economics / Q000494:pharmacology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000191:economics*; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D017048:Health Care Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000494:pharmacology; D008297:Male; D008687:Metformin / Q000191:economics / Q000494:pharmacology; D008875:Middle Aged; D017059:Models, Econometric; D000077715:Nateglinide; D019982:Organizational Case Studies; D017063:Outcome Assessment, Health Care / Q000191:economics*; D010649:Phenylalanine / Q000031:analogs & derivatives* / Q000191:economics / Q000494:pharmacology; D014481:United States
chemical_list: D001786:Blood Glucose; D003510:Cyclohexanes; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; D000077715:Nateglinide; D010649:Phenylalanine