A randomised trial of the effect and cost-effectiveness of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with screen-detected type 2 diabetes: the Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION-Europe) study
Background: Intensive treatment (IT) of cardiovascular risk factors can halve mortality among people with established type 2 diabetes but the effects of treatment earlier in the disease trajectory are uncertain. Objective: To quantify the cost-effectiveness of intensive multifactorial treatment of screen-detected diabetes. Design: Pragmatic, multicentre, cluster-randomised, parallel-group trial. Setting: Three hundred and forty-three general practices in Denmark, the Netherlands, and Cambridge and Leicester, UK. Participants: Individuals aged 40–69 years with screen-detected diabetes. Interven... Mehr ...
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Dokumenttyp: | Artikel |
Erscheinungsdatum: | 2016 |
Reihe/Periodikum: | Health Technology Assessment, Vol 20, Iss 64 (2016) |
Verlag/Hrsg.: |
NIHR Journals Library
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Schlagwörter: | randomised controlled trial / type 2 diabetes / screening / cardiovascular / intensive treatment / primary care / Medical technology / R855-855.5 |
Sprache: | Englisch |
Permalink: | https://search.fid-benelux.de/Record/base-27406067 |
Datenquelle: | BASE; Originalkatalog |
Powered By: | BASE |
Link(s) : | https://doi.org/10.3310/hta20640 |
Background: Intensive treatment (IT) of cardiovascular risk factors can halve mortality among people with established type 2 diabetes but the effects of treatment earlier in the disease trajectory are uncertain. Objective: To quantify the cost-effectiveness of intensive multifactorial treatment of screen-detected diabetes. Design: Pragmatic, multicentre, cluster-randomised, parallel-group trial. Setting: Three hundred and forty-three general practices in Denmark, the Netherlands, and Cambridge and Leicester, UK. Participants: Individuals aged 40–69 years with screen-detected diabetes. Interventions: Screening plus routine care (RC) according to national guidelines or IT comprising screening and promotion of target-driven intensive management (medication and promotion of healthy lifestyles) of hyperglycaemia, blood pressure and cholesterol. Main outcome measures: The primary end point was a composite of first cardiovascular event (cardiovascular mortality/morbidity, revascularisation and non-traumatic amputation) during a mean [standard deviation (SD)] follow-up of 5.3 (1.6) years. Secondary end points were (1) all-cause mortality; (2) microvascular outcomes (kidney function, retinopathy and peripheral neuropathy); and (3) patient-reported outcomes (health status, well-being, quality of life, treatment satisfaction). Economic analyses estimated mean costs (UK 2009/10 prices) and quality-adjusted life-years from an NHS perspective. We extrapolated data to 30 years using the UK Prospective Diabetes Study outcomes model [version 1.3; © Isis Innovation Ltd 2010; see www.dtu.ox.ac.uk/outcomesmodel (accessed 27 January 2016)]. Results: We included 3055 (RC, n = 1377; IT, n = 1678) of the 3057 recruited patients [mean (SD) age 60.3 (6.9) years] in intention-to-treat analyses. Prescription of glucose-lowering, antihypertensive and lipid-lowering medication increased in both groups, more so in the IT group than in the RC group. There were clinically important improvements in cardiovascular risk factors in both study ...