Evidence map›Paper›PMID 8555801›Full record

ArticleBMJ (Clinical research ed.)1995

Screening to prevent renal failure in insulin dependent diabetic patients: an economic evaluation.

B A Kiberd, K K Jindal

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 1995. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

27 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
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  11. The Cost-Effectiveness of an Advanced Hybrid Closed-Loop System in People with Type 1 Diabetes: a Health Economic Analysis in Sweden.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2021
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  15. Cost-Effectiveness of Liraglutide Versus Dapagliflozin for the Treatment of Patients with Type 2 Diabetes Mellitus in the UK.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2017
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

2 authors.

B A KiberdDepartment of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
K K Jindal

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo examine the conditions necessary to make screening for microalbuminuria in patients with insulin dependent diabetes mellitus cost effective.

designThis economic evaluation compared two strategies designed to prevent the development of end stage renal disease in patients with insulin dependent diabetes with disease for five years. Strategy A, screening for microalbuminuria as currently recommended, was compared with strategy B, a protocol in which patients were screened for hypertension and macroproteinuria.

interventionPatients identified in both strategies were treated with an angiotensin converting enzyme inhibitor.

settingComputer simulation.

main outcome measuresStrategy costs and quality adjusted life years (QALYs).

resultsThe model predicted that strategy A would produce an additional 0.00967 QALYs at a present value cost of $261.53 (1990 US$) per patient (or an incremental cost/QALY of $27,041.69) over strategy B. The incremental cost/QALY for strategy A over B was sensitive to several variables. If the positive predictive value of screening for microalbuminuria (impact of false label and unnecessary treatment) is < 0.72, the effect of treatment to delay progression from microalbuminuria to macroproteinuria is < 1.6 years, the cumulative incidence of diabetic nephropathy falls to < 20%, or > 64% of patients demonstrate hypertension at the onset of microalbuminuria, then the incremental costs/QALY will exceed $75,000.

conclusionWhether microalbuminuria surveillance in this population is cost effective requires more information. Being aware of the costs, recommendation pitfalls, and gaps in our knowledge should help focus our efforts to provide cost effective care to this population.

Indexed as

AlbuminuriaAngiotensin-Converting Enzyme InhibitorsClinical ProtocolsComputer SimulationCost-Benefit AnalysisCosts and Cost AnalysisDiabetes Mellitus, Type 1Evaluation Studies as TopicFollow-Up StudiesHumansHypertensionKidney Failure, ChronicQuality-Adjusted Life YearsAngiotensin-Converting Enzyme Inhibitors

Identifiers

PMID8555801
PMCPMC2551496

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.