Identified evidence suggests that cardiovascular disease ( CVD ) prevention services should consider regulation of blood glucose as a key target for intervention .
The primary objective of this study was to analyze the most up-to- date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review .
What determines the cost-effectiveness of diabetes screening?
Aims /hypothesisThe cost-effectiveness of screening for diabetes is unknown but has been modelled previously . None of these models has taken account of uncertainty . We aim ed to describe these uncertainties in a model where the outcome was CHD risk . Subjects and methods Our model used population data from the Danish Inter99 study , and simulations were run in a theoretical population of 1,000,000 individuals . CHD risk was estimated using the UK Prospect i ve Diabetes Study ( UKPDS ) risk engine , and risk reduction from published r and omised clinical trials . Probabilistic sensitivity analysis was used to provide confidence intervals for modelled outputs . Uncertain parameter values were independently simulated from distributions derived from existing literature and deterministic sensitivity analysis performed using multiple model runs under different strategy choices and using extreme parameter estimates . Results In the least conservative model ( low costs and multiplicative risk reduction for combined treatments ) , the 95 % confidence interval of the incremental cost-effectiveness ratio varied from £ 23,300–82,000 . The major contributors to this uncertainty were treatment risk reduction model parameters : the risk reduction for hypertension treatment and UKPDS risk model intercept . Overall cost-effectiveness ratio was not sensitive to decisions about which groups to screen , nor the costs of screening or treatment . It was strongly affected by assumptions about how treatments combine to reduce risk . Conclusions /interpretationOur model suggests that there is considerable uncertainty about whether or not screening for diabetes would be cost-effective . The most important but uncertain parameter is the effect of treatment . In addition to directly influencing current policy decisions , health care modelling can identify important unknown or uncertain parameters that may be the target of future research
Identified evidence suggests that cardiovascular disease ( CVD ) prevention services should consider regulation of blood glucose as a key target for intervention .
The primary objective of this study was to analyze the most up-to- date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review .