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Intense Multifactorial Treatment for Type 2 Diabetes Shown to be Cost Effective: Steno 2 Study

Jul 7, 2018
 

Analysis of European Steno 2 study examines long-term economic implications of interventions targeting complications.

When patients with type 2 diabetes (T2D) receive intensified, multifactorial treatment combining lifestyle modification and pharmacological therapy for modifiable risk factors, there is no significant increase in medical costs, compared to patients who receive conventional, multifactorial treatment, according to the study, “A Cost Analysis of Intensified vs. Conventional Multifactorial Therapy of Patients with Type 2 Diabetes—The Steno 2 Study,” presented at the American Diabetes Association’s® (ADA’s) 78th Scientific Sessions® at the Orange County Convention Center. The study showed that people with T2D have an increased risk of damage to the eyes, kidneys, nerves, legs, heart, and brain. any of these complications can affect mortality.

The 1993 Steno 2 study investigated whether a targeted, intensified, multifactorial regimen would have an impact on the mortality rate of patients with T2D from any cause, including cardiovascular causes. The trial enrolled 160 Danish people with T2D with consistent microalbuminuria and an average age of 55 years. Small amounts of albumin in the urine indicates generalized blood vessel damage and is a strong predictor of premature, multiple organ damage.

The patients were randomly assigned to two groups: 80 patients received conventional multifactorial treatment, based upon recommendations of the Danish Medical Association at the time. Eighty patients received intensified multifactorial intervention. In the intensified treatment group, all modifiable risk factors were treated, and the group’s target levels for blood glucose, HbA1c, blood pressure, total cholesterol, LDL cholesterol, and triglycerides were lower than those for the conventional treatment group. Treatment focused on polypharmacological approaches to cardiovascular issues, as well as improved health behaviors via nutrition, exercise, and smoking cessation.

After 7.8 years of treatment, the people in the intensified treatment group had an approximate 50 percent reduction in diabetes-related damage to the heart, brain, and legs, compared to the patients receiving conventional care. All patients were subsequently followed observationally for an average of 5.5 years in a post-trial setting in which all study participants received intensified, multifactorial treatment. At 13.3 years follow-up, the group originally allocated to intensified treatment had a 50 percent reduction in mortality, and at 21.2 years follow-up, a median of 7.9 years of gain of life was demonstrated. The increase in lifespan was matched by the amount of time the patients were without cardiovascular disease incidents.

The current analysis compared the long-term economic implications of the intensified multifactorial intervention to conventional treatment over the 21.2-year timeframe. Information on direct health costs was gathered from Danish health registers. Researchers found no difference in total direct medical costs between the intensified treatment group and the conventional treatment group over the 21.2 years of follow-up. The total costs in the intensified treatment group was approximately $13 million, and total costs in the conventional treatment group was $12.3 million (p=0.19). The data also indicated a statistically significant lower health cost per-patient, per-year in the intensified treatment group ($9,648 per patient), compared to the conventional treatment group ($10,681 per patient; p=0.13) during the entire follow-up period.

Intensified treatment was, on average, more expensive in terms of medication costs, but less costly in terms of primary care visits and inpatient admission services related to cardiovascular issues.

“The Steno-2 trial was instrumental in establishing treatment standards for people with T2D. so it was important that we weighed the costs of the intensified multifactorial treatment recommended in the study,” said junior lead study author Joachim Gaede, a graduate student in the medicine program at the University of Copenhagen in Denmark.  They discovered that while intensified, multifactorial treatment may lead to an initial increase in health care costs, this investment is recouped over time by the health benefits and increased longevity. The total direct costs of intensified, multifactorial intervention, which leads to decreased diabetes complications in longer-life length of about eight years, was neutral compared to conventional treatment.

So, in terms of cost, investing in early-intensified intervention of modifiable risk factors in high-risk individuals with T2D may pay for itself over time due to a reduced cost of complications incurred by patients.

From the results of the study with an average follow-up of 21.2 years, researchers found no significant increase in total costs or in costs per person year was associated with intensified multipronged treatment for 7.8 years when compared to conventional multi-pronged treatment. Considering the gain of years of life and health benefits achieved with intensified treatment, they concluded that intensified multifaceted intervention in high-risk patients with type 2 diabetes is highly cost-effective.

Practice Pearls:

  • At 13.3 years follow-up, the group originally allocated to intensified treatment had a 50 percent reduction in mortality, and at 21.2 years follow-up, a median of 7.9 years of gain of life was demonstrated.
  • The increase in lifespan was matched by the amount of time the patients went without cardiovascular disease incidents.
  • It was concluded that intensified multifaceted intervention in high-risk patients with type 2 diabetes is highly cost-effective.

ADA 78th Scientific Sessions, Orlando 2018