***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The aim of this study was to project health-economic outcomes relevant to the German setting for the addition of pioglitazone to existing treatment regimens in patients with type 2 diabetes , evidence of macrovascular disease and at high risk of cardiovascular events . Methods Event rates corresponding to macrovascular outcomes from the Prospect i ve Pioglitazone Clinical Trial in Macrovascular Events ( PROactive ) study of pioglitazone were used with a modified version of the CORE Diabetes Model to simulate outcomes over a 35-year time horizon . Direct medical costs were accounted from a healthcare payer perspective in year 2005 values . Germany specific costs were applied for patient treatment , hospitalization and management . Both costs and clinical benefits were discounted at 5.0 % per annum . Results Over patient lifetimes pioglitazone treatment improved undiscounted life expectancy by 0.406 years and improved quality -adjusted life expectancy by 0.120 quality -adjusted life years ( QALYs ) compared to placebo . Direct medical costs ( treatment plus complication costs ) were marginally higher for pioglitazone treatment and calculation of the incremental cost-effectiveness ratio ( ICER ) produced a value of € 13,294 per QALY gained with the pioglitazone regimen versus placebo . Acceptability curve analysis showed that there was a 78.2 % likelihood that pioglitazone would be considered cost-effective in Germany , using a " good value for money " threshold of € 50,000 per QALY gained . Sensitivity analyses showed that the results were most sensitive to changes in the simulation time horizon . After adjustment for the potential stabilization of pancreatic β-cell function with pioglitazone treatment , the ICER was € 6,667 per QALY gained for pioglitazone versus placebo . Conclusion The findings of this modelling analysis indicated that , for patients with a history of macrovascular disease , addition of pioglitazone to existing therapy reduces the long-term cumulative incidence of diabetes-complications at a cost that would be considered to represent good value for money in the German setting OBJECTIVES The aim of this study is to examine the cost-effectiveness of a group-based peer support intervention in general practice for patients with type 2 diabetes . METHODS Incremental cost utility analysis combining within trial and beyond trial components to compare the lifetime costs and benefits of alternative strategies : CONTROL st and ardized diabetes care ; INTERVENTION group-based peer support in addition to st and ardized diabetes care . Within trial analysis was based on a cluster r and omized controlled trial of 395 patients with type 2 diabetes in the east of Irel and . Beyond trial analysis was conducted using the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) Outcomes Model . Uncertainty was explored using a range of sensitivity analyses and cost-effectiveness acceptability curves were generated . RESULTS Compared with the control strategy , the intervention was associated with an increase of 0.09 ( 95 percent confidence interval [ CI ] , -0.05 to 0.25 ) in mean quality -adjusted life-years per patient and savings of € 637.43 ( 95 percent CI , -2455.19 to 1125.45 ) in mean healthcare cost per patient and € 623.39 ( 95 percent CI , -2507.98 to 1298.49 ) in mean total cost per patient respectively . The likelihood of the intervention being cost-effective was appreciably higher than 80 percent for a range of potential willingness-to-pay cost-effectiveness thresholds . CONCLUSIONS Our results suggest that while a group-based peer support intervention shows a trend toward improved risk factor management , we found no significant differences in final cost or effectiveness endpoints between intervention and control . The probabilistic results suggest that the intervention was more cost-effective , with probability values of higher than 80 percent across a range of potential cost-effectiveness threshold values Background : The benefits of self-monitoring blood glucose levels are unclear in patients with type 2 diabetes mellitus who do not use insulin , but there are considerable costs . We sought to determine the cost effectiveness of self-monitoring for patients with type 2 diabetes not using insulin . Methods : We performed an incremental cost-effectiveness analysis of the self-monitoring of blood glucose in adults with type 2 diabetes not taking insulin . We used the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) model to forecast diabetes-related complications , corresponding quality -adjusted life years and costs . Clinical data were obtained from a systematic review comparing self-monitoring with no self-monitoring .  Costs and utility decrements were derived from published sources . We performed sensitivity analyses to examine the robustness of the results . Results : Based on a clinical ly modest reduction in hemoglobin A1C of 0.25 % ( 95 % confidence interval 0.15–0.36 ) estimated from the systematic review , the UKPDS model predicted that self-monitoring performed 7 or more times per week reduced the lifetime incidence of diabetes-related complications compared with no self-monitoring , albeit at a higher cost ( incremental cost per quality -adjusted life year $ 113 643 ) . The results were largely unchanged in the sensitivity analysis , although the incremental cost per quality -adjusted life year fell within widely cited cost-effectiveness thresholds when testing frequency or the price per test strip was substantially reduced from the current levels . Interpretation : For most patients with type 2 diabetes not using insulin , use of blood glucose test strips for frequent self-monitoring ( ≥ 7 times per week ) is unlikely to represent efficient use of finite health care re sources , although periodic testing ( e.g. , 1 or 2 times per week ) may be cost-effective . Reduced test strip price would likely also improve cost-effectiveness OBJECTIVE —The efficacy and safety of adding liraglutide ( a glucagon-like peptide-1 receptor agonist ) to metformin were compared with addition of placebo or glimepiride to metformin in subjects previously treated with oral antidiabetes ( OAD ) therapy . RESEARCH DESIGN AND METHODS —In this 26-week , double-blind , double-dummy , placebo- and active-controlled , parallel-group trial , 1,091 subjects were r and omly assigned ( 2:2:2:1:2 ) to once-daily liraglutide ( either 0.6 , 1.2 , or 1.8 mg/day injected subcutaneously ) , to placebo , or to glimepiride ( 4 mg once daily ) . All treatments were in combination therapy with metformin ( 1 g twice daily ) . Enrolled subjects ( aged 25–79 years ) had type 2 diabetes , A1C of 7–11 % ( previous OAD monotherapy for ≥3 months ) or 7–10 % ( previous OAD combination therapy for ≥3 months ) , and BMI ≤40 kg/m2 .  RESULTS —A1C values were significantly reduced in all liraglutide groups versus the placebo group ( P < 0.0001 ) with mean decreases of 1.0 % for 1.8 mg liraglutide , 1.2 mg liraglutide , and glimepiride and 0.7 % for 0.6 mg liraglutide and an increase of 0.1 % for placebo . Body weight decreased in all liraglutide groups ( 1.8–2.8 kg ) compared with an increase in the glimepiride group ( 1.0 kg ; P < 0.0001 ) . The incidence of minor hypoglycemia  with liraglutide ( ∼3 % ) was comparable to that with placebo but less than that with glimepiride ( 17 % ; P < 0.001 ) . Nausea was reported by 11–19 % of the liraglutide-treated subjects versus 3–4 % in the placebo and glimepiride groups . The incidence of nausea declined over time . CONCLUSIONS —In subjects with type 2 diabetes , once-daily liraglutide induced similar glycemic control , reduced body weight , and lowered the occurrence of hypoglycemia compared with glimepiride , when both had background therapy of metformin BACKGROUND AND OBJECTIVES Exenatide , a GLP-1 receptor agonist for adjuvant treatment of type 2 diabetes mellitus ( T2DM ) , has been shown to be as effective as insulin glargine ( IG ) for reducing glycated hemoglobin levels combined with metformin or/ and sulphonylureas . Exenatide is associated to weight reduction and a higher incidence of gastrointestinal adverse events . The objective of this study was to assess the cost-effectiveness of exenatide as compared to IG in obese patients with T2DM not achieving an adequate blood glucose control from the perspective of the Spanish healthcare system . METHODS Pharmacoeconomic model inputs were obtained from an obese sub population ( BMI ≥ 30 k/m(2 ) ) of an international , r and omized , controlled clinical trial comparing exenatide with IG in poorly controlled T2DM patients , and were supplemented with country-specific data . RESULTS Exenatide was associated to improvements in life-years gained and quality -adjusted life years ( QALYs ) by 0.11 and 0.62 respectively versus IG . Direct costs were € 9,306 higher as compared to IG ( € 47,010 versus € 37,704 , with increased pharmacy costs as the main driver  ) . Exenatideís  incremental cost-effectiveness ratio was € 15,068 per QALY gained versus IG . CONCLUSIONS Exenatide was associated to greater clinical benefits and higher costs in obese T2DM patients as compared to IG . Considering a willingness-to-pay threshold of € 30,000 per QALY gained in the Spanish setting  , exenatide represents an efficient option in comparison with IG OBJECTIVES This analysis provides an early estimate of the cost-effectiveness of adjunctive exenatide in treating type 2 diabetes mellitus in the United States . Data from pivotal phase III 30-week clinical trials and 52 weeks of their subsequent open-label extension studies ( i.e. , 82 weeks total ) were used to project the effects of 30 years of adjunctive exenatide treatment . METHODS This analysis utilized a published and vali date d Markov model incorporating Monte Carlo simulation with tracker variables to estimate the clinical and cost outcomes of adding exenatide to a background of metformin and /or sulfonylurea treatment , with the effects of 30 years of adjunctive exenatide treatment ( projected from data from 82 weeks of exenatide treatment ) compared with no additional treatment beyond metformin and /or a sulfonylurea . Sensitivity analyses were performed on key clinical assumptions , discount rates , and shorter time horizons . RESULTS The base-case scenario ( 30 years of exenatide ) yielded an incremental cost-effectiveness ratio ( ICER ) of $ 35,571 . We found that shortening the time horizons and removing the lipid effects of exenatide had the greatest negative impact on ICERs when performing sensitivity analysis . CONCLUSIONS Our analysis demonstrated that exenatide used for 20 or 30 years compared with no additional treatment beyond metformin and /or a sulfonylurea is cost-effective in the adjunctive treatment of type 2 diabetes with an ICER less than $ 50,000 per life-year gained . Sensitivity analyses suggest that , in addition to sustained reduction in HbA(1c ) , the added clinical effects of improved lipid values , systolic blood pressure , and reduced body mass index all positively contributed to the cost-effectiveness of exenatide OBJECTIVE To develop and vali date a comprehensive computer simulation model to assess the impact of screening , prevention , and treatment strategies on type 2 diabetes and its complications , comorbidities , quality of life , and cost . RESEARCH DESIGN AND METHODS The incidence of type 2 diabetes and its complications and comorbidities were derived from population -based epidemiologic studies and r and omized , controlled clinical trials . Health utility scores were derived for patients with type 2 diabetes using the Quality of Well Being-Self-Administered . Direct medical costs were derived for managed care patients with type 2 diabetes using paid insurance cl aims . Monte Carlo techniques were used to implement a semi-Markov model .  Performance of the model was assessed using baseline and 4- and 10-year follow-up data from the older-onset diabetic population studied in the Wisconsin Epidemiologic Study of Diabetic Retinopathy ( WESDR ) . RESULTS Applying the model to the baseline WESDR population with type 2 diabetes , we predicted mortality to be 51 % at 10 years . The prevalences of stroke and myocardial infa rct ion were predicted to be 18 and 19 % at 10 years . The prevalences of nonproliferative diabetic retinopathy , proliferative retinopathy , and macular edema were predicted to be 45 , 16 , and 18 % , respectively ; the prevalences of microalbuminuria , proteinuria , and end-stage renal disease were predicted to be 19 , 39 , and 3 % , respectively ; and the prevalences of clinical neuropathy and amputation were predicted to be 52 and 5 % , respectively , at 10 years . Over 10 years , average undiscounted total direct medical costs were estimated to be USD $ 53,000 per person . Among survivors , the average utility score was estimated to be 0.56 at 10 years . CONCLUSIONS 
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An inverse exponential relationship was found and fitted between the ratio ( ∆QALY/∆LE ) and ∆HbA1c .
Conclusion There is a consistent relationship between ∆HbA1c and ∆QALYs or ∆LE in cost-effectiveness analyses using type 2 diabetes simulation models .