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Cost-effectiveness of Glycemic and Hypertension Control, and Cholesterol Reduction for Type 2 Diabetes

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Press Release, May 14, 2002
Study examines cost-effectiveness of treatment interventions for type 2 diabetes.

Source: Sorensen S, Engelgau M, Thompson T, Narayan V, Williamson D, Gregg E, Zhang P. CDC Cost-effectiveness of intensive glycemic, intensified hypertension control, and serum cholesterol level reduction for type 2 diabetes. JAMA 2002 May 15;287(19):2542-51.

The following is a Centers for Disease Control and Prevention (CDC) statement on the results of a study by the Diabetes Cost-effectiveness Group. The study showed that intensive hypertension control over a lifetime in people with diabetes reduces costs and improves health.

The CDC diabetes study estimates the cost-effectiveness of intensive glycemic (blood glucose) control, intensified hypertension (high blood pressure) control, and reduction in serum cholesterol levels relative to standard care for patients with type 2 diabetes. The results of the study will guide medical practice, especially for hypertension control.

How was the study performed?

The study was performed using a mathematical model of disease progression that calculated cost per quality-adjusted-life-year (QALY) gained. Costs and QALY were discounted at a 3% annual rate, which is standard for medical interventions.

In reality, it means a time-preference for good health today versus good health tomorrow. The discount rate adjusts both costs per QALY for this time preference.

Key messages from this study

(1) Intensified hypertension control over a lifetime in people with diabetes reduces costs and improves health outcomes as follows:

  • Intensified hypertension control lowers average blood pressure to 144/82 over a lifetime in people with diabetes.
  • It also reduces costs and improves health outcomes relative to moderate hypertension control that lowers average blood pressure to 154/86.
  • The cost-effectiveness ratio was minus $1,959 per QALY so cost-savings from the intervention are greater than the costs of the intervention. An intervention that is cost-saving should always be implemented unless there are risks from side effects.

(2) Intensive glycemic control and reduction in serum cholesterol level over a lifetime in people with diabetes increase costs but improve health outcomes. Both cost-effectiveness ratios are comparable to other frequently adopted health care interventions.

  • For intensive glycemic control, the cost-effectiveness ratio was $41,384 per QALY.
  • For reduction in serum cholesterol levels, the cost-effectiveness ratio was $51,889 per QALY.

(3) The cost-effectiveness ratios for all interventions varied by age at diagnosis, but intensified hypertension controls were always cost-saving.

(4) What is a Quality-Adjusted-Life-Year?

The Quality-Adjusted-Life-Year measures the years of life saved by an intervention. The value of each year is adjusted for a condition or complication, such as blindness or amputation. A person with no sickness will have a QALY of 1.0, and one who dies may have a QALY of 0. In comparison, a blind person may have a QALY of 0.6.

(5) What does the cost-effectiveness ratio mean?

The cost-effectiveness ratio measures the value of an intervention. The first step is to compare the cost of the intervention to no intervention and then divide it by QALY versus not having the intervention. The goal is to achieve one of the following:

  • Good — improve QALY as much as possible, hold down the cost
  • Better — maintain a smaller cost-effectiveness ratio
  • Best — put into practice a cost-saving intervention improving QALY

The cost-effectiveness ratio measures the value of an intervention by calculating the change in cost versus not having the intervention divided by the change in QALY versus not having the intervention.

  • Intensive hypertension control is cost-saving and improves health.
  • Intensive glycemic control and reducing cholesterol increase costs but improve health.
  • The cost-effectiveness ratios for these two interventions are comparable with other health care interventions.

Questions and Answers

1. Who is involved in the study? Who will benefit?

The study was performed by the CDC Diabetes Cost-effectiveness Group that includes people from CDC’s Division of Diabetes Translation, the Research Triangle Institute, and outside experts in diabetes, coronary heart disease, and cost-effectiveness analysis.

The study will benefit health policymakers, public health officials, health care systems, and medical practitioners dealing with the long-term effects of type 2 diabetes to make decisions that enhance care with acceptable costs.

2. What is it all about?

The study estimated the cost-effectiveness of intensive glycemic control, intensified hypertension control, and reduction in serum cholesterol levels relative to standard care for patients with type 2 diabetes. The results of the study can guide medical practice, especially hypertension control.

3. Where does the study take place?

The study is a statistical model of diabetes disease progression that is based on results from the United Kingdom Prospective Diabetes Study (UKPDS) and other clinical trials. Costs are based on community practices in the United States.

4. When does the study take place?

A hypothetical cohort of patients newly diagnosed with diabetes and with possible complications, including above-average cholesterol and above-average hypertension, are followed throughout their lives. The patients may develop complications including nephropathy (kidney disease), neuropathy (nerve disease), retinopathy (eye disease), coronary heart disease, and stroke.

5. Why was the study done?

The treatment of type 2 diabetes with intensive glycemic control, intensified hypertension control, or serum cholesterol reduction may reduce complications of diabetes, but the relative cost-effectiveness of these interventions was not known.

Although treatment for type 2 diabetes has traditionally focused on glycemic control for reducing microvascular complications, recent attention has also focused on reducing the risks of macrovascular complications.

  • Microvascular disease: disease of the smallest blood vessels, such as those found in the eyes, nerves, and kidneys
  • Macrovascular disease: disease of the large blood vessels, such as those found in the heart.

People with type 2 diabetes have twice the risk for coronary heart disease and stroke as people without diabetes; available interventions to reduce these diseases in people with diabetes include aggressive hypertension control and reducing serum cholesterol level. This study evaluates the relative cost-effectiveness and health benefits of these interventions.

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Page last modified: December 20, 2005

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