Scenario
The NHS has identified key areas for health improvement. These include heart disease, diabetes, smoking and control of hypertension. The prevalence of type 2 diabetes is around 4% nationally, and is higher in your region because of the large ethnic population. Your PCT has bid for, and won, a modest sum of money to improve the care of people with type 2 diabetes. The manager in charge of the regional project recognises that she cannot improve all the elements of diabetes care within the allocated sum and has convened an advisory committee to help her prioritise the possible treatments. Because of your training in the assessment of health technologies you are invited to join this committee. The three areas for which clinicians have requested additional funding are:
- improving the glycaemic control of diabetics
- improving the cholesterol level of diabetics
- improving the control of hypertension in diabetics
The first committee meeting is chaotic and there are advocates for each area. A quick search on the Cochrane Library reveals no current Cochrane reviews on the topic - the review on the treatment of hypertension in diabetes having been withdrawn because it was out of date. Before the next meeting you ask your local health care librarian to search for evidence to inform the debate. He provides you with the following paper: Cost-effectiveness of intensive glycemic control, intensified hypertension control, and serum cholesterol lever reduction for type 2 diabetes. CDC Diabetes Cost-effectiveness Group. JAMA 2002 187(19):2543-2551.
It is important to bear this scenario in mind when you are reading the paper - a study can be perfectly well conducted and yet not provide relevant information for the context of the decision you are making. Also remember you are not reading the paper to see if it is perfect, but are reading it to see whether it is sufficiently free of bias and trustworthy so that it can to be of use for informing your decision in your particular context.
The paper...
Please read the paper which can be downloaded by clicking here. Use the CASP checklist to help you appraise this paper critically. It can be downloaded as a PDF file that you can print up and write on by clicking here. We recommend that you do this to have a record of your answers.
The Quiz...
Please read the paper with the CASP checklist then click here to test your knowledge...
