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. 2018 Feb 6;168(3):170-178.
doi: 10.7326/M17-0537. Epub 2017 Dec 12.

Individualized Glycemic Control for U.S. Adults With Type 2 Diabetes: A Cost-Effectiveness Analysis

Neda Laiteerapong  1 , Jennifer M Cooper  1 , M Reza Skandari  1 , Philip M Clarke  2 , Aaron N Winn  3 , Rochelle N Naylor  1 , Elbert S Huang  1
Affiliations

Individualized Glycemic Control for U.S. Adults With Type 2 Diabetes: A Cost-Effectiveness Analysis

Neda Laiteerapong et al. Ann Intern Med. .

Abstract

Background: Intensive glycemic control in type 2 diabetes (glycated hemoglobin [HbA1c] level <7%) is an established, cost-effective standard of care. However, guidelines recommend individualizing goals on the basis of age, comorbidity, diabetes duration, and complications.

Objective: To estimate the cost-effectiveness of individualized control versus uniform intensive control (HbA1c level <7%) for the U.S. population with type 2 diabetes.

Design: Patient-level Monte Carlo-based Markov model.

Data sources: National Health and Nutrition Examination Survey 2011-2012.

Target population: The approximately 17.3 million persons in the United States with diabetes diagnosed at age 30 years or older.

Time horizon: Lifetime.

Perspective: Health care sector.

Intervention: Individualized versus uniform intensive glycemic control.

Outcome measures: Average lifetime costs, life-years, and quality-adjusted life-years (QALYs).

Results of base-case analysis: Individualized control saved $13 547 per patient compared with uniform intensive control ($105 307 vs. $118 854), primarily due to lower medication costs ($34 521 vs. $48 763). Individualized control decreased life expectancy (20.63 vs. 20.73 years) due to an increase in complications but produced more QALYs (16.68 vs. 16.58) due to fewer hypoglycemic events and fewer medications.

Results of sensitivity analysis: Individualized control was cost-saving and generated more QALYs compared with uniform intensive control, except in analyses where the disutility associated with receiving diabetes medications was decreased by at least 60%.

Limitation: The model did not account for effects of early versus later intensive glycemic control.

Conclusion: Health policies and clinical programs that encourage an individualized approach to glycemic control for U.S. adults with type 2 diabetes reduce costs and increase quality of life compared with uniform intensive control. Additional research is needed to confirm the risks and benefits of this strategy.

Primary funding source: National Institute of Diabetes and Digestive and Kidney Diseases.

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Conflict of interest statement

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0537.

Figures

Appendix Figure 2
Appendix Figure 2
Participant flow chart.
Appendix Figure 1
Appendix Figure 1
U.S. Type 2 Diabetes Policy Model. All individual NHANES participants were simulated to receive both glycemic interventions, and 2500 independent simulation replications were performed for each patient. CHF = congestive heart failure; ESRD = end-stage renal disease; HbA1c = glycated hemoglobin; IHD = ischemic heart disease; MI = myocardial infarction; NHANES = National Health and Nutrition Examination Survey.
Figure 1
Figure 1
Diabetes-related complications (top) and hypoglycemic events (bottom), by glycemic control strategy.
Figure 2
Figure 2
Sensitivity analysis of medication disutility. QALY = quality-adjusted life-year. *Represents difference between individualized vs. uniform intensive glycemic goals.
See this image and copyright information in PMC

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References

    1. American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36:1033–46. doi: 10.2337/dc12-2625. - DOI - PMC - PubMed
    1. CDC Diabetes Cost-effectiveness Group. Cost-effectiveness of intensive glycemic control, intensified hypertension control, and serum cholesterol level reduction for type 2 diabetes. JAMA. 2002;287:2542–51. - PubMed
    1. Gerstein HC, Miller ME, Genuth S, Ismail-Beigi F, Buse JB, Goff DC, Jr, et al. ACCORD Study Group. Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med. 2011;364:818–28. doi: 10.1056/NEJMoa1006524. - DOI - PMC - PubMed
    1. Lipska KJ, Ross JS, Wang Y, Inzucchi SE, Minges K, Karter AJ, et al. National trends in US hospital admissions for hyperglycemia and hypoglycemia among Medicare beneficiaries, 1999 to 2011. JAMA Intern Med. 2014;174:1116–24. doi: 10.1001/jamainternmed.2014.1824. - DOI - PMC - PubMed
    1. Huang ES, Laiteerapong N, Liu JY, John PM, Moffet HH, Karter AJ. Rates of complications and mortality in older patients with diabetes mellitus: the Diabetes and Aging Study. JAMA Intern Med. 2014;174:251–8. doi: 10.1001/jamainternmed.2013.12956. - DOI - PMC - PubMed

Web-Only References

    1. Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA. 1999;281:2005–12. - PubMed
    1. Lee KJ, Carlin JB. Multiple imputation for missing data: fully conditional specification versus multivariate normal imputation. Am J Epidemiol. 2010;171:624–32. doi: 10.1093/aje/kwp425. - DOI - PubMed
    1. National Center for Health Statistics. National Health Interview Survey Diabetes Supplement. Hyattsville, MD: National Center for Health Statistics; 2006.
    1. Centers for Medicare & Medicaid Services. Physician Fee Schedule - January 2012 release. Baltimore: Centers for Medicare & Medicaid Services; 2012. [on 10 November 2017]. Accessed at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/....
    1. Harris S, Mamdani M, Galbo-Jørgensen CB, Bøgelund M, Gundgaard J, Groleau D. The effect of hypoglycemia on health-related quality of life: Canadian results from a multinational time trade-off survey. Can J Diabetes. 2014;38:45–52. doi: 10.1016/j.jcjd.2013.09.001. - DOI - PubMed

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