Item #12
Cost
Effectiveness Options for Treating Type 2 Diabetes
Intensified
hypertension control appears to be the most cost effective
Three
alternative interventions targeting type 2 diabetes are as cost
effective as traditional management, reported Thomas J. Hoerger,
Ph.D., and his associates in the Centers for Disease Control and
Prevention Diabetes Cost-Effectiveness Group.
Their cost-effectiveness model assessed three alternative
interventions—intensive glycemic control, intensified hypertension
control, and reduction in serum cholesterol—based on results from
the U.K. Prospective Diabetes Study, and costs of complications taken
from the literature (JAMA 287[19]:2542-51, 2002). The hypothetical
patient cohort included adults aged 25 years and older with newly
diagnosed type 2 diabetes. They received standard treatment, including
conventional glycemic control yielding a 7.9% average glycosylated
hemoglobin level, plus one of the three alternatives.
Intensified hypertension control reduced complication costs by an
average of $4,836 during patients' lifetimes, and reduced the
cumulative incidence of retinopathy, nephropathy, and complications
from stroke, compared with other interventions. This yielded a
negative cost-effectiveness ratio per quality-adjusted life-year:
-$1,959, vs. a net cost of $41,384 for intensive glycemic control and
$51,889 for cholesterol reduction.
Intensive glycemic control reduced the cumulative rate of
complications from nephropathy, neuropathy, and retinopathy. Reduction
in serum cholesterol reduced complications relating to coronary heart
disease and stroke, but these reductions were outweighed by increased
complication costs for neuropathy, nephropathy, and retinopathy due to
extended life expectancy.
Intensified hypertension control appears to be the most cost effective
from a policy standpoint, but physicians should note that intervention
effects vary with the ages and risk profiles of newly diagnosed type 2
diabetes patients. Comparisons may aid in choosing one intervention
over another, but the study did not address the nonmedical costs of
diabetes.
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