Long-term health economic benefits of sensor-augmented pump therapy vs continuous subcutaneous insulin infusion alone in type 1 diabetes: a UK perspective

Aims/hypothesis:

Continuous subcutaneous insulin infusion (CSII) is an important treatment option for type 1 diabetes patients unable to achieve adequate glycemic control with multiple daily injections (MDI). Combining CSII with continuous glucose monitoring (CGM) in sensor-augmented pump therapy (SAP) with a low glucose-suspend (LGS) feature may further improve glycemic control and reduce the frequency of hypoglycemia. A cost-effectiveness analysis of SAP?+?LGS vs CSII plus self-monitoring of blood glucose (SMBG) was performed to determine the health economic benefits of SAP?+?LGS in type 1 diabetes patients using CSII in the UK.

Methods:

Cost-effectiveness analysis was performed using the CORE diabetes model. Treatment effects were sourced from the literature, where SAP?+?LGS was associated with a projected HbA_1c reduction of ?1.49% vs ?0.62% for CSII, and a reduced frequency of severe hypoglycemia. The time horizon was that of patient lifetimes; future costs and clinical outcomes were discounted at 3.5% and 1.5% per annum, respectively.

Results:

Projected outcomes showed that SAP?+?LGS was associated with higher mean quality-adjusted life expectancy (17.9 vs 14.9 quality-adjusted life years [QALYs], SAP?+?LGS vs CSII), and higher life expectancy (23.8 vs 21.9 years), but higher mean lifetime direct costs (GBP 125,559 vs GBP 88,991), leading to an incremental cost-effectiveness ratio (ICER) of GBP 12,233 per QALY gained for SAP?+?LGS vs CSII. Findings of the base-case analysis remained robust in sensitivity analyses.

Conclusions/interpretation:

For UK-based type 1 diabetes patients with poor glycemic control, the use of SAP?+?LGS is likely to be cost-effective compared with CSII plus SMBG.     

Cost-effectiveness of continuous subcutaneous insulin infusion in people with type 2 diabetes in the Netherlands

Aims: Up to 30% of insulin-treated type 2 diabetes patients are unable to achieve HbA1c targets despite optimization of insulin multiple daily injections (MDI). For these patients the use of continuous subcutaneous insulin infusion (CSII) represents a useful but under-utilized alternative. The aim of the present analysis was to examine the cost-effectiveness of initiating CSII in type 2 diabetes patients failing to achieve good glycemic control on MDI in the Netherlands. Methods: Long-term projections were made using the IMS CORE Diabetes Model. Clinical input data were sourced from the OpT2mise trial. The analysis was performed over a lifetime time horizon. The discount rates applied to future costs and clinical outcomes were 4% and 1.5% per annum, respectively. Results: CSII was associated with improved quality-adjusted life expectancy compared with MDI (9.38 quality-adjusted life years [QALYs] vs 8.95 QALYs, respectively). The breakdown of costs indicated that ～50% of costs were attributable to diabetes-related complications. Higher acquisition costs of CSII vs MDI were partially offset by the reduction in complications. The ICER was estimated at EUR 62,895 per QALY gained and EUR 60,474 per QALY gained when indirect costs were included. Conclusions: In the Netherlands, CSII represents a cost-effective option in patients with type 2 diabetes who continue to have poorly-controlled HbA1c despite optimization of MDI. Since the ICER falls below the willingness-to-pay threshold of EUR 80,000 per QALY gained, CSII is likely to represent good-value for money in the treatment of poorly-controlled T2D patients compared with MDI.     

Where do We Go From Here? New Perspectives on the Black Box in Strategic Human Resource Management Research

The main objective of the present research is to briefly review the strategic human resource management (HRM) literature from multilevel theoretical perspectives to summarize what we know about mediating mechanisms in the HR–performance relationship. By doing so, we highlight future research needs to advance theoretical understanding of the ‘black box’ in strategic HRM research. Furthermore, by offering additional theoretical perspectives that can be used to understand the mediating mechanisms at different levels, we suggest future research directions that capture the complexities associated with strategic HRM through a multilevel theoretical lens. Implications of the model are discussed.     

解读晋商恰克图贸易衰落的深层原因

恰克图贸易的迅速衰落始于1862年签订的《中俄陆路通商条约》,恰克图贸易衰落的原因在于商贸制度不公平、商贸环境恶化、商贸条件的变化、机器大工业发展与西方市场经济的影响。晋帮茶商衰落的深层次原因在于其代表的传统商贸活动方式不适应于社会化大生产和市场经济的发展要求。外国的侵犯和本国政府的腐败是导致其走向衰落的直接诱因。     

陕南茶叶产业化发展的战略研究

优越的生态条件和悠久的种茶历史为陕南茶叶产业化发展提供了良好的基础。然而,受传统自然经济和计划经济等多种因素的影响,陕南茶叶还存在产业布局不合理、规模小、管理混乱、经营分散等方面的问题。必须坚持以市场为导向,通过理顺茶业行政管理体系、创新茶叶生产经营机制、推行标准化生产、健全服务体系、实施名牌战略才能实现陕南茶叶产业跨越式发展。     

黑土生态系统脆弱性成因与修复

黑土生态系统脆弱性成因自然因素和人为因素共同作用的结果;自然因素是水土流失发生发展的潜在条件,人为因素对水土流失的发生发展起了促进和加速作用;遵循生物种群与环境相适应原则,对不同地貌类型导致生物生态分异,生物种群必须与地貌格局相一致;将黑土脆弱区分为3个生态系统进行生态修复。     

Investment responses to Japanese tax reforms: A cross-industry comparison

This paper examines the investment responses to past Japanese tax reforms for individual industries. To identify the tax effect, this paper estimates investment functions by using a covariate of the change in tax-adjusted q caused by tax reform. This method alleviates the measurement error problem and enables the derivation of estimates indicating the valid adjustment cost of investment. Moreover, the findings suggest that firms’ investment responded significantly to tax reforms in the 1980s in general. Also, investments of only a few industries responded to those in the late 1990s, implying that the manner of investment response slightly differs among industries.     

安化黑茶的审美表现

安化黑茶历史悠久,制作古朴,呈现出沧桑原始之美。茶叶外形粗糙,凸显遒劲神韵和原始、粗犷之美。在清幽环境中,观红橙汤色,品黑茶淡淡的松烟香,更是一种于物质中寻求超物质的独特享受。黑茶具有多种功效,给人的身心以美的享受。黑茶以陈显优,一度成为收藏佳品。     

Cultural Connotation of Black in English and Chinese

There is a close relationship between language and culture. Language is not only an important part of culture, but also a mirror of culture, which reflects the numerous and complicated cultural forms of a nation. Both English and Chinese have a large number of words expressed by the word black;nevertheless, great dif erences exist in the application of black, and the cultural connotations in both English and Chinese dif er. In order to communicate ef ectively and successful y across these two cultures, we should understand their cultural connotations accurately and use black properly.     

茶文化旅游的开发与设计

现代旅游不仅是经济消费,更是文化消费,茶文化旅游正是以它传统的养生和休闲方式,独特的观光和体验价值,高享受的服务,迎合了现代旅游业的发展趋势,有着广阔的发展空间。本文界定了茶文化旅游的涵义,并基于对茶文化旅游开发意义的理解,探究了如何深入开发茶文化旅游,以促进茶业、旅游业的发展和"三农"问题的解决。同时,针对茶文化旅游开发中的重点——产品设计,本文还进一步研究了如何遵循茶文化旅游产品设计的原则,充分利用现有茶文化旅游资源设计出受欢迎的茶文化旅游项目和旅游线路。