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Diabetes Care Publish Ahead of Print published online ahead of print April 28, 2008
DOI: 10.2337/dc07-2452
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Original Research

Cost-effectiveness of Intensified versus conventional multifactorial intervention in type 2 diabetes: Results and projections from the steno-2 study

Peter Gæde, MD, DMSci1, William J Valentine, PhD2, Andrew J Palmer, MBBS2, Daniel MD Tucker, MBBS2, Morten Lammert, MSc3, Hans-Henrik Parving, MD, DMSci4,,5 and Oluf Pedersen, MD, DMSci1,,5

1Steno Diabetes Center, Copenhagen, Denmark
2IMS Health, Allschwil, Switzerland
3Novo Nordisk Scandinavia, Copenhagen, Denmark
4Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
5Faculty of Health Science, Aarhus University, Aarhus, Denmark

phag{at}steno.dk

ABSTRACT

Objective: To assess the cost-effectiveness of intensive versus conventional therapy for 8 years as applied in the Steno-2 study in patients with type 2 diabetes and microalbuminuria.

Research Design and Methods: A Markov model was developed to incorporate event and risk data from Steno-2 and account Danish-specific costs to project life expectancy, quality-adjusted life expectancy (QALE) and lifetime direct medical costs expressed in year 2005 Euro values. Clinical and cost outcomes were projected over patient lifetimes and discounted at 3% annually. Sensitivity analyses were performed.

Results: Intensive treatment was associated with increased life expectancy and QALE, and increased lifetime costs, compared to conventional treatment. Mean undiscounted life expectancy was 18.1±7.9 years with intensive treatment and 16.2±7.3 years with conventional treatment (difference 1.9 years). Discounted life expectancy values were 13.4±4.8 (intensive) versus 12.4±4.5 years (conventional). Lifetime costs (discounted) for intensive and conventional treatment were {euro} 45,521±19,697 and {euro} 41,319±27,500, respectively (difference {euro} 4,202). Increased costs with intensive treatment were due to increased pharmacy and consultation costs. Discounted QALE was 1.66 quality-adjusted life years (QALYs) higher on intensive (10.2±3.6 QALYs) versus conventional (8.6±2.7 QALYs) treatment, resulting in an incremental cost-effectiveness ratio of {euro} 2,538 per QALY gained. This is considered a conservative estimate since prescription of generic drugs and capturing indirect costs would further favor intensified therapy.

Conclusions: Intensive therapy was cost-effective versus conventional treatment from a healthcare payer perspective in Denmark. Assuming that patients in both arms were treated in a primary care setting, intensive therapy became dominant (cost-and life saving).


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