Study Examines Cost-effectiveness of Treatment

Interventions for Type 2 Diabetes

Aggressive treatment of high blood pressure can improve health outcomes while reducing a diabetes patient's lifetime health care costs by about $1,000, according to a new study by the Centers for Disease Control and Prevention (CDC). Aggressive treatment involves the use of anti-hypertensive medications, in addition to conventional treatment of diet and diabetes drugs, to achieve recommended levels of blood pressure control.

Researchers also found that aggressive blood pressure treatment would reduce stroke by 44 percent and directly reduce cumulative incidence of nephropathy (kidney disease) and retinopathy (eye disease) among people with diabetes. Diabetes is a leading cause of blindness, kidney disease and stroke.

The study, "Cost-effectiveness of Intensive Glycemic Control Intensified Hypertension Control and Serum Cholesterol Level Reduction for Type 2 Diabetes," which appears in this week’s Journal of the American Medical Association ( www.jama.com ), also examined the cost-effectiveness and health outcomes of intensive glycemic (blood sugar) control and reduction of serum cholesterol. Aggressive treatment versus conventional treatment in both cases significantly improved health outcomes, although costs increased.

"People with diabetes are at considerable risk for heart disease, strokes and other serious health complications," said David Fleming, M.D. acting CDC director. "This study confirms that aggressive treatment interventions aimed at reducing the risks of cardiovascular disease increase life expectancy and, at the same time, may reduce lifetime health care costs," Dr. Fleming said.

To determine whether intensive glycemic control, intensified blood pressure, or reduction in serum cholesterol levels among diabetes patients justified the incurred health care costs, the CDC Diabetes Cost-effectiveness Group used a mathematical model of disease progression to evaluate the benefits of each intervention and calculate its incremental cost-effectiveness ratio. The researchers used a hypothetical cohort of individuals living in the United States aged 25 years or older who were newly diagnosed with type 2 diabetes. Costs were measured from the perspective of the health care system (indirect costs such as patient time or care giver costs were not considered) and outcomes were measured in quality-adjusted life years (QALYs).

Of the three interventions, intensive hypertension control was the most cost-effective, followed by intensive glycemic control and a reduction in serum cholesterol level.

Intensive glycemic control involved obtaining the best possible control of blood sugar through diet and the use of insulin, chlorpropamide and glipizide. Costs included drug therapy, outpatient visits, self-testing and case management. Intensive glycemic control reduced the cumulative incidence of nephropathy, neuropathy, (nerve damage) and retinopathy complications by 11 percent to 27 percent. Intensive glycemic control appeared to be more cost-effective for younger diabetes patients than for older patients.

Reducing serum cholesterol levels using the cholesterol-lowering drug pravastatin increased life expectancy in the model and reduced coronary heart disease by 25 percent. As a result, health costs increased over time. Assuming that patients would receive pravastatin for their remaining lifetime, the cost-effectiveness of this intervention improved as the patient aged and their risk of heart disease increased.

"The key findings of the cost-effectiveness study group provide valuable information to policy makers who decide which interventions to adopt," said Frank Vinicor, M.D., director of CDC's diabetes division. "This model offers a way to evaluate the cost-effectiveness of interventions for type 2 diabetes that produce benefits for years, or even decades, after the interventions begin."

Approximately one million cases of diabetes are diagnosed each year among people aged 20 or older. Most (90 percent to 95 percent) have type 2 diabetes, which is associated with older age, obesity and physical inactivity.

To obtain a copy of "Cost-effectiveness of Intensive Glycemic Control Intensified Hypertension Control and Serum Cholesterol Level Reduction for Type 2 Diabetes," call 770-488-5131. For more information on diabetes, visit the CDC's Web site at www.cdc.gov/diabetes (877-232-3422) or call toll free: 1-877-CDC-DIAB.

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