Health economics and chronic disease, with a specific focus on diabetes
AffiliationMelbourne School of Population and Global Health
Document TypePhD thesis
Access StatusOpen Access
© 2018 Dr Xinyang Hua
Chronic diseases, which refer to diseases that are of long duration and generally slow progression, cause more than half of the deaths worldwide today and bring heavy economic burden on both individuals and health systems. Health economic evaluation has been a useful tool for the management of chronic diseases, as it takes account of cost in decision-making and usually measures long-term health outcomes from health interventions. This thesis studies on chronic diseases, with a special emphasis on diabetes, from a health economics perspective. It applies a wide range of health economics methods, with an endeavour to fill in the gaps in existing literature and provide new evidence and practical tools for chronic diseases. The thesis includes six individual studies, which can be divided into three main parts: • Cost analysis— The first part of this thesis focuses on the cost of chronic diseases. It includes two individual studies. The first study explores the potential of using administrative data to build indices and thus more efficiently evaluate on out-of-pocket expenditure. It then applies this method on four chronic disease patient groups. The second study demonstrates the trend on cost and price of insulin and other diabetes medications in the United State from 2002 to 2013. • Risk prediction on long-term health outcomes— The second part of this thesis includes two studies on long-term risk prediction, with an emphasis on regional differences. The first study recalibrates the widely used Framingham cardiovascular disease (CVD) risk equations in an Australian Indigenous cohort. The recalibrated equation corrects the underestimation and provides better CVD risk predictions in this population. The second study examines whether the predictive power of self-rated health on mortality in type 2 diabetes patients is different across different regions of the world. • The use of simulation modelling— Simulation modelling is a useful tool in health economics studies, since it can help to replicate the clinical process of a disease and extrapolate intermediate health effects into long-term outcomes. It is widely used in diseases with a complex and long process like diabetes. The last part of this thesis focuses on simulation modelling in type 2 diabetes. It includes a systematic review and meta-analysis on published model-based type 2 diabetes economic evaluations, and a self-built Asian type 2 diabetes simulation model that incorporates self-rated health as a novel predictor.
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