Cost-effectiveness
of Intensive Glycemic Control
Controlling
blood pressure, blood glucose and cholesterol reduces costs and
improves the quality of life.
The Objective of this
study was to estimate the incremental cost-effectiveness
of intensive glycemic control (relative to conventional control),
intensified hypertension control, and reduction in serum cholesterol
level for patients with type 2 diabetes.
Design,
Setting, and Patients Cost-effectiveness analysis of
a hypothetical cohort of individuals living in the United States, aged
25 years or older, who were newly diagnosed as having type 2 diabetes.
The results of the United Kingdom Prospective Diabetes Study (UKPDS)
and other studies were used to create a model of disease progression
and treatment patterns. Costs were based on those used in community
practices in the United States.
Interventions Insulin
or sulfonylurea therapy for intensive glycemic control; angiotensin-converting
enzyme inhibitor or Beta-blocker for intensified hypertension control;
and pravastatin for reduction of serum cholesterol level.
Main
Outcome Measures Cost per quality-adjusted life-year
(QALY) gained. Costs (in 1997 US dollars) and QALYs were discounted at
a 3% annual rate.
Results The
incremental cost-effectiveness ratio for intensive glycemic control is
$41 384 per QALY; this ratio increased with age at diagnosis from
$9614 per QALY for patients aged 25 to 34 years to $2.1 million for
patients aged 85 to 94 years. For intensified hypertension control the
cost-effectiveness ratio is -$1959 per QALY. The cost-effectiveness
ratio for reduction in serum cholesterol level is $51 889 per
QALY; this ratio varied by age at diagnosis and is lowest for patients
diagnosed between the ages of 45 and 84 years.
Conclusions Intensified
hypertension control reduces costs and improves health outcomes
relative to moderate hypertension control. Intensive glycemic control
and reduction in serum cholesterol level increase costs and improve
health outcomes. The cost-effectiveness ratios for these 2
interventions are comparable with those of several other frequently
adopted health care interventions. JAMA.
2002;287:2542-2551
