The Triglycerides and Glucose Index: A Cost-Effectiveness Analysis Compared With the Homeostatic Model Assessment for Insulin Resistance

Abstract

Objectives: This study aimed to evaluate the cost-effectiveness of the triglycerides and glucose index (TyG) versus the homeostatic model assessment for insulin resistance index (HOMA-IR) for diagnosing insulin resistance.

Methods: A cost-effectiveness analysis using a decision tree based on the false-negative and false-positive tests and the true-positive and true-negative tests of both the TyG and HOMA-IR was conducted. Based on the costs and effectiveness of both tests, the average and incremental cost-effectiveness ratios were calculated. Furthermore, one-way sensitivity analysis was conducted regarding sensitivity of both indexes. Using the Monte Carlo simulation with 10 000 iterations, a probabilistic sensitivity analysis that included sensitivity, specificity, and cost of diagnostic tests was conducted. Finally, using the α and β values obtained from the primary data, the beta distribution was used for estimation of sensitivity and specificity.

Results: The cost-effectiveness per test was $1.64 versus $4.26 for TyG and HOMA-IR. The effectiveness of true-positive (0.77 vs 0.74) and true-negative (0.17 vs 0.15) tests was higher for the TyG than HOMA-IR. The cost-effectiveness ratio was lower for the TyG than the HOMA-IR, for both the true-positive ($1.64 vs $4.26) and true-negative ($7.33 vs $20.70) tests. Diagnosing IR using the TyG was 61.5% lower than using the HOMA-IR.

Conclusions: Our findings indicate that the TyG is a high effectiveness and cost-effective test for diagnosing insulin resistance than the HOMA-IR.

Keywords: cost-effectiveness; homeostatic model assessment for insulin resistance index; insulin resistance; triglycerides and glucose index.