Seminar Jinender

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Seminar in second semester

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Seminar Jinender

  1. 1. Cost-effectiveness of Biphasic insulin aspart 70/30 vs. insuline glargine in the US Jinender Kumar
  2. 2. Question 1 <ul><li>Was a well-defined question posed in answerable form? – Yes. </li></ul><ul><ul><li>To project the long term clinical and economic outcome of treatment with biphasic insulin aspart 30 vs. insulin glagrine in insulin naïve type 2 diabetes failing to achieve glycemic control with oral anti-diabetic agent alone. </li></ul></ul>
  3. 3. Question 2 <ul><li>Was a comprehensive description of the competing alternatives given? – Yes. </li></ul><ul><ul><li>BIAsp 70/30 twice daily: fasting plasma glucose (FPG) < 180 mg/dl, 10 units daily; FPG ≥ 180 mg/dl, 12 units daily. insulin glargine once daily target FPG and evening glucose values: 80-110 mg/dl </li></ul></ul>
  4. 4. Question 3 <ul><li>Was there evidence that the programs' effectiveness had been established? – Yes. </li></ul><ul><ul><li>INITIATE study was done through a randomized, controlled clinical trial. The effectiveness was established. </li></ul></ul>
  5. 5. Question 4 <ul><li>Were all important and relevant costs and consequences for each alternative identified? – Yes. </li></ul><ul><ul><li>The range was wide enough for the research question at hand. </li></ul></ul><ul><ul><li>It is from the perspective of a third-party payer. </li></ul></ul>
  6. 6. Question 5 <ul><li>Were costs and consequences measured accurately in appropriate physical units prior to valuation? – Yes. </li></ul><ul><ul><li>Any identified items were not omitted from measurement. </li></ul></ul><ul><ul><li>There were some special circumstances that made measurement difficult such as cost per event of diabetes-related complications. These circumstances were handled appropriately. </li></ul></ul>
  7. 7. Question 6 <ul><li>Were costs and consequences valued credibly? – Yes. </li></ul><ul><ul><li>The sources of all values were clearly identified. </li></ul></ul><ul><ul><li>The valuation of consequences was appropriate for the question posed. Cost-effectiveness was selected to be the appropriate type of analysis. </li></ul></ul>
  8. 8. Question 7 <ul><li>Were costs and consequences adjusted for differential timing? – Yes. </li></ul><ul><ul><li>Costs and consequences were that occurred in the future &quot;discounted&quot; to their present values. </li></ul></ul>
  9. 9. Question 8 <ul><li>Was an incremental analysis of costs and consequences of alternatives performed? – Yes. </li></ul><ul><ul><li>The additional (incremental) costs generated by the use of one alternative over another was compared with the additional effects, benefits or utilities generated. </li></ul></ul><ul><ul><li>Incremental cost-effectiveness ratio (ICER): lifetime ICER, and ICER in patients with baseline HbA 1c ≥ 8.5% </li></ul></ul>
  10. 10. Question 9 <ul><li>Was a sensitivity analysis performed? – Yes. </li></ul><ul><ul><li>Justification was provided for the ranges of values (for key parameters) used in the sensitivity analysis. </li></ul></ul><ul><ul><li>The study results were not sensitive to changes in the values (within the assumed range). </li></ul></ul>
  11. 11. Question 10 <ul><li>Did the presentation and discussion of the results of the study include all issues of concern to users? – Yes. </li></ul><ul><ul><li>The conclusions of the analysis were based on cost-effectiveness ratio. </li></ul></ul><ul><ul><li>The study discussed the generalizability of the results to other settings and patient groups. </li></ul></ul>

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