Issue 136 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.