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Health Utility along the Diabetes Continuum - Examination of utility values in impaired glucose metabolism using pre-scored multi-attribute utility instruments

Type 2 Diabetes (T2D), a disease characterized by a continuum of impaired glucose metabolism, is a major health threat and a financial burden to modern societies. Health care systems, which are aimed at maximizing the population’s health and wellbeing, face decisions on how to allocate limited health care resources to provide as much health as possible in such a way that also accounts for population preferences for different health states.

Health utility is a metric developed specifically to account for those preferences and to allow comparable estimation of health benefits or decrements associated with different health states. However, to make informed decisions, both health economic evaluations and health utility data are needed. Unfortunately, published data regarding the health utility values for precursors of T2D along the diabetes continuum did not exist when this study was initiated.

In his doctoral thesis, Saku Väätäinen, MSc, aimed to examine whether the health utility is associated with the impaired glucose metabolism and at what point on the diabetes continuum is the health utility affected meaningfully; how do other factors affect this relationship; and whether the risk factors and the overall diabetes risk are associated with health utility.

The thesis was based on the cross-sectional data from the ongoing longitudinal Savitaipale Study, comprising 920 study subjects born between 1933 and 1956, and still participating in the 10-year follow-up visit in 2007-2008. The thesis contains three separate studies, and a systematic literature review (SLR) carried out to complement the published empirical data analyses. In the present study, health utility was measured with two pre-scored preference-based multi-attribute utility instruments, 15D and SF-6D. Glucose metabolism status was determined with the oral glucose tolerance test (OGTT) and patient records. The risk factors and patient characteristics were examined individually and as an accumulation of risk factors, defined by non-invasive questionnaire-based Finnish Diabetes Risk Score, FINDRISC.

Based on the data and the SLR, it is evident that impaired glucose metabolism, overall diabetes risk and the accumulation of risk factors are associated with decreased health utility. It is likely that health utility is meaningfully affected long before the person is diagnosed with T2D. While present findings can be utilized in future health economic evaluations and research as well as aiding in decision making, further studies will be needed to validate these results, to examine the potential causal pathways and to evaluate the impact of individual risk factors.

The doctoral dissertation of Saku Väätäinen, Master of Science (Pharmacy), entitled Health Utility along the Diabetes Continuum, Examination of utility values in impaired glucose metabolism using pre-scored multi-attribute utility instruments, will be examined at the Faculty of Health Sciences. The Opponent in the public examination will be Docent Arto Strandberg of the University of Helsinki, and the Custos will be Professor Janne Martikainen of the University of Eastern Finland.

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