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Just How Expensive Is Diabetes?

Nov 28, 2013

New cost-effective analysis attempts to determine blood glucose targets to determine persons at high risk for type 2 diabetes development and for diabetes prevention…. 

Diabetes is an expensive disease with estimated total annual costs due to diagnosed diabetes in the U.S. at $245 billion in 2012. So what can we do to lower this economic burden? Researchers at the U.S. Centers for Disease Control and Prevention (CDC) assessed data of people without diabetes from the 2006-2010 National Health and Nutritional Examination Survey and used simulation models of cost-effectiveness as compared to different fasting plasma glucose (FPG) goals/targets in order to identify the most cost-effective blood glucose target of persons at high risk for developing type 2 diabetes. They investigated the change in lifetime quality adjusted life years (QALYs) and the medical costs associated with different FPG thresholds between 90-120 mg/dL (in 5mg/dL increments).

Adults aged >45 years old were included in the study and researchers found that as FPG targets were reduced, QALYs, cost and cost per QALY increased. The cost per QALY gained increased from $30,100, to $32,900, $42,300, $60,700, $81,800, and $115,800 respectively as FPG targets decreased in increments of 5 from 120-90 mg/dL. If one is to use the standard of $50,000/QALY as cost-effective, then FPG levels at 105mg/dL and higher would be considered cost effective to determining persons at high risk of developing diabetes/preventing diabetes.

These numbers show us a nice trend and demonstrate that lower FPG targets can lead to improving diabetes prevention but at a higher cost. But really, what is the value of someone’s life? Can you put a true cost/number on preventing diabetes? The costs associated with diabetes are astronomical and the impact on quality life is priceless if you ask most diabetics. Currently we define impaired fasting glucose as a FPG level of 100-125 mg/dL so this study does not support economic benefit in lowering FPG targets. But, if FPG levels are a part of the normally assessed laboratory values, then we can still educate patients on appropriate diet and physical activity to keep their blood glucose at lower target levels and hopeful prevent some diabetes cases.

Practice Pearls:
  • Lowering FPG levels improve diabetes prevention. However this comes at a higher cost.
  • Current FPG targets are <126 mg/dL (for diabetes) and a FPG of 100-125 mg/dL indicates a person has impaired fasting glucose.
  • This study demonstrates that targeting a FPG of 105 mg/dL or higher is "cost-effective" when using the standard $50,000/QALY threshold; however, the $50,000/QALY threshold should be carefully considered in this patient population.

Diabetes Care, October 2013- Zhuo, X. et al. Cost-Effectiveness of Alternative Thresholds of the Fasting Plasma Glucose Test to Identify the Target Population for Type 2 Diabetes Prevention in Adults Aged ≥45 Years. Diabetes Care. Published online ahead of print October 17, 2013.