Model of Complications of NIDDM: II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia

TLDR

The study analyzes the health benefits and economic impact of treating non‑insulin dependent diabetes mellitus (NIDDM) to achieve normoglycemia. An incidence‑based simulation model of NIDDM was used, adjusting complication hazard rates for glycemia with DCCT risk gradients, estimating treatment costs from national surveys and trials, and expressing incremental costs and benefits in present‑value dollars (3% discount rate) while converting life‑years to quality‑adjusted life‑years. The model predicts that maintaining HbA1c at 7.2% reduces blindness, end‑stage renal disease, and lower‑extremity amputation by 72%, 87%, and 67% respectively, increases life expectancy by 1.39 years, raises cardiovascular risk by 3%, raises treatment costs nearly twofold but offsets these with lower complication costs, and yields an incremental cost‑effectiveness ratio of about $16,000 per QALY, which is considered cost‑effective, especially for patients with longer glycemic exposure, minorities, and higher baseline HbA1c.

Abstract

To analyze the health benefits and economics of treating NIDDM with the goal of normoglycemia.Incidence-based simulation model of NIDDM was used. Hazard rates for complications were adjusted for glycemia using risk gradients from the Diabetes Control and Complications Trial. Treatment costs were estimated from national survey data and clinical trials. Incremental costs and benefits were expressed in present value dollars (3% discount rate). Life-years were adjusted for quality of life, yielding quality-adjusted life-years (QALYs).Comprehensive treatment of NIDDM that maintains an HbA1c value of 7.2% is predicted to reduce the cumulative incidence of blindness, end-stage renal disease, and lower-extremity amputation by 72, 87, and 67%, respectively. Cardiovascular disease risk increased by 3% (no effect of treating glycemia is assumed). Life expectancy increased 1.39 years. The cost of treating hyperglycemia increased by almost twofold, which is partially offset by reductions in the cost of complications. The estimated incremental cost/QALY gained is $16,002. Treatment is more cost-effective for those with longer glycemic exposure (earlier onset of diabetes), minorities, and those with higher HbA1c under standard care.The incremental effectiveness of treating NIDDM with the goal of normoglycemia is estimated to be approximately $16,000/QALY gained, which is in the range of interventions that are generally considered cost-effective.