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

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 € 45,521±19,697 and € 41,319±27,500, respectively (difference € 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 € 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).