The 30-year cost-effectiveness of alternative strategies to achieve excellent glycemic control in type 1 diabetes: An economic simulation informed by the results of the diabetes control and complications trial/epidemiology of diabetes interventions and complications (DCCT/EDIC)

J Diabetes Complications. 2018 Oct;32(10):934-939. doi: 10.1016/j.jdiacomp.2018.06.005. Epub 2018 Jun 12.

Abstract

Objective: To simulate the cost-effectiveness of historical and modern treatment scenarios that achieve excellent vs. poor glycemic control in type 1 diabetes (T1DM).

Research design and methods: We describe and compare the costs of intensive and conventional therapies for T1DM as performed during DCCT, and modern intensive and basic therapy scenarios using insulin analogs, pens, pumps, and continuous glucose monitoring (CGM) to achieve excellent or poor glycemic control. We then assess the differences in treatment costs and the costs of outcomes over 30 years and report incremental cost-effectiveness ratios.

Results: Over 30 years, DCCT intensive therapy cost $127,500 to $181,600 more per participant than DCCT conventional therapy, and modern intensive therapy cost $87,700 to $409,000 more per individual than modern basic therapy. Excellent glycemic control averted as much as $90,900 in costs from complications and added ~1.62 quality-adjusted life-years (QALYs) per participant over 30 years. When costs and QALYs were discounted at 3% annually, DCCT intensive therapy and modern intensive therapies that use multiple daily injections (MDI) or pumps are cost-saving or cost-effective (<$100,000/QALY-gained). If applied to all patients with T1DM, modern intensive therapy using pumps and CGM is not cost-effective (>$250,000/QALY-gained) but would be more cost-effective if associated with less hypoglycemia, better glycemic control, fewer complications, or improved health-related quality-of-life.

Conclusions: Use of the least expensive intensive therapy needed to safely achieve treatment goals for patients with T1DM represents a good value for money.

Trial registration: clinicaltrials.govNCT00360815 and NCT00360893.

Keywords: Continuous glucose monitoring; Cost-effectiveness; Insulin pump therapy; Multiple daily injections; Type 1 diabetes.

Publication types

  • Clinical Trial

MeSH terms

  • Blood Glucose / analysis
  • Blood Glucose / metabolism*
  • Blood Glucose Self-Monitoring / economics
  • Blood Glucose Self-Monitoring / instrumentation
  • Blood Glucose Self-Monitoring / methods
  • Computer Simulation
  • Cost-Benefit Analysis
  • Diabetes Complications / economics
  • Diabetes Complications / epidemiology
  • Diabetes Complications / etiology
  • Diabetes Complications / therapy
  • Diabetes Mellitus, Type 1 / blood*
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / economics*
  • Diabetes Mellitus, Type 1 / epidemiology
  • Glycated Hemoglobin A / analysis
  • Glycated Hemoglobin A / metabolism*
  • Health Care Costs
  • Humans
  • Insulin / administration & dosage
  • Insulin / economics
  • Insulin Infusion Systems / economics
  • Models, Economic
  • Quality of Life
  • Quality-Adjusted Life Years

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Insulin

Associated data

  • ClinicalTrials.gov/NCT00360815
  • ClinicalTrials.gov/NCT00360893