An individualized approach to glucose control in type 2 diabetes can save billions of dollars over time nationwide due to decreased medication costs and would slightly improve quality of life compared with uniform intensive control (HbA1C level < 7 percent). Findings from a cost analysis study are published in Annals of Internal Medicine.
Diabetes is a substantial public health and financial burden in the U.S., costing an estimated $245 billion annually. As such, understanding the cost-effectiveness of treatment is imperative. Previously, the American Diabetes Association (ADA) recommended intensive glycemic control for all patients with type 2 diabetes, in part based on cost-effectiveness data. Since then, several studies have shown that intensive glycemic control may be associated with more harm than benefit for some patients and, therefore, a more individualized approach could be warranted. However, the cost-effectiveness of this approach is not known.
Researchers at the University of Chicago Medicine used a statistical model that calculated health care costs over the average expected lifetime for 569 patients in the National Health and Nutrition Examination Survey (NHANES) who were representative of the population of U.S. adults over the age of 30 with type 2 diabetes. The model factored in variables such as age, duration of diabetes and history of complications, such as heart disease, hypertension, stroke, retinopathy and kidney disease. It assigned costs for typical type 2 diabetes treatment regimens with drugs like metformin, insulin and sulfonylureas, and included standard values from the research literature for the cost of treating major events, like a heart attack or stroke.
The model showed that individualized control strategy saved on average $13,564 per person compared to the uniform strategy ($105,307 vs. $118,853 lifetime). The difference was almost entirely due to lower medication costs ($34,521 vs. $48,763). Given that roughly 17.3 million adults in the U.S. over 30 have type 2 diabetes, this could amount to a $234 billion lifetime savings nationwide.