估计糖尿病预防计划的基于风险的价值:基于临床试验的成本效益如何适用于现实世界?
medRxiv : the preprint server for health sciences
|December 8, 2025
概括
符合国家糖尿病预防计划 (NDPP) 资格的现实世界人口的糖尿病风险低于最初的糖尿病预防计划 (DPP) 试验队列. 个性化风险评估可以优化预防计划对不同人群的好处.
科学领域:
- 公共卫生 公共卫生
- 卫生经济学 卫生经济学
- 预防医学 预防医学
背景情况:
- 临床试验数据可能不准确地反映现实世界的人口和干预的有效性.
- 对糖尿病预防计划的经济评估需要对试验数据和现实数据进行比较.
研究的目的:
- 将原始糖尿病预防计划 (DPP) 临床试验人口和符合国家糖尿病预防计划 (NDPP) 资格的现实世界人口之间的糖尿病预防干预措施的风险和成本效益进行比较.
主要方法:
- 利用国家健康和营养检查调查 (NHANES) 数据来识别符合NDPP资格的个人,调整调查权重以代表美国人口.
- 采用临床预测模型进行个人糖尿病风险估计和微模拟进行终身成本和效益分析.
- 在DPP试验和NHANES现实世界人口之间,对生活方式干预和甲胺的净货币收益 (NMB) 的比较.
主要成果:
- 只有20%的NDPP资格的NHANES参与者符合DPP试验纳入标准.
- 与DPP试验人群相比,现实世界NHANES人群的3年糖尿病风险平均值 (14.6%) 和中位数 (4.8%) 较低 (平均值19.7%,中位数10.3%).
- 生活方式干预为DPP试验群体平均NMB为34,889美元,而NHANES群体为28,652美元.
结论:
- 符合NDPP资格的现实世界人口包括较高比例的低风险个人,可能从预防计划中获得较小的好处.
- 个性化糖尿病风险评估对于优化转诊和优先级,最大限度地提高预防计划在现实环境中的影响至关重要.
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