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Theme: CLAHRC - Diagnostics & Stratified Medicine
Monogenic diabetes usually presents in patients under the age of 30 years, and so is often misdiagnosed as type 1 diabetes leading to patients receiving more invasive and costly treatment than is necessary. Identifying these individuals and changing their treatment to that which is more appropriate could lead to cost savings to the NHS.
We undertook an economic evaluation of four strategies to identifying individuals with monogenic diabetes from the perspective of the NHS, and compared them to a strategy where no attempt to identify individuals is made.
The four strategies are:
We have developed a decision analytic model to evaluate these strategies. This evaluation is part of a larger study to estimate the prevalence of monogenic diabetes and assess the impact on patients of changing their treatment (based on a misdiagnosed) to more appropriate treatment based on a diagnosis of monogenic diabetes. The project was funded by the Health Innovation Challenge Fund, a parallel funding partnership between the Wellcome Trust and the Department of Health.
The project aims to:
Peters JL, Anderson R, Hyde C (2013) Development of an economic evaluation of diagnostic strategies: the case of monogenic diabetes. BMJ Open 3:e002905.
Shields BM, Shepherd M, Hudson M, McDonald TJ, Colclough K, Peters J, Knight B, Hyde C, Ellard S, Pearson ER, Hattersley AT (2017) Population-Based Assessment of a Biomarker-Based Screening Pathway to Aid Diagnosis of Monogenic Diabetes in Young-Onset Patients. Diabetes Care; 40:1017-1025
The results of our evaluation have been submitted for publication.
We are currently looking to develop this work further to address clinically relevant questions related to the identification and subsequent treatment change for individuals with monogenic diabetes.
Shields B, Peters J, Cooper C, Lowe J, Knight BA, Powell RJ, Jones A, Hyde C, Hattersley AT. Can clinical features be used to differentiate type 1 from type 2 diabetes? A systematic review of the literature. BMJ Open 2015; 5:11
Rob Anderson, Bev Shields, Sophie King, Michelle Hudson, Maggie Shepherd, Tim McDonald, Ewan Pearson, Andrew Hattersley