Model of Complications of NIDDM: II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia

Richard C Eastman; Jonathan C Javitt; William H Herman; Erik J Dasbach; Catherine Copley-Merriman; William Maier; Fred Dong; Diane Manninen; Arthur S Zbrozek; James Kotsanos; Sanford A Garfield; Maureen Harris

doi:10.2337/diacare.20.5.735

Original Article

Model of Complications of NIDDM: II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia

Richard C Eastman, MD,
Jonathan C Javitt, MD,
William H Herman, MD,
Erik J Dasbach, PHD,
Catherine Copley-Merriman, MBA,
William Maier, PHD,
Fred Dong,
Diane Manninen, PHD,
Arthur S Zbrozek, MBA,
James Kotsanos, MD,
Sanford A Garfield, PHD and
Maureen Harris, PHD

Division of Diabetes, Endocrinology, Metabolic Diseases Indianapolis, Indiana
National Institute of Diabetes and Digestive and Kidney Diseases Bethesda, Maryland Department of Opthalmology Indianapolis, Indiana
Worthen Center for Eye Care Research, Georgetown University, School of Medicine Washington, D.C. Department of Internal Medicine Indianapolis, Indiana
Division of Endocrinology and Metabolism, University of Michigan, Epidemiology and Outcomes Research Indianapolis, Indiana
Parke-Davis Inc. Ann Arbor, Michigan Merck Inc. Indianapolis, Indiana
Bluebell, Pennsylvania Battelle Inc. Indianapolis, Indiana
Seattle, Washington Bayer Inc. Indianapolis, Indiana
West Haven, Connecticut Eli Lilly Inc. Indianapolis, Indiana

Address correspondence and reprint requests to Richard C. Eastman, MD, Director, Division of Diabetes, Endocrinology, and Metabolic Diseases, NIDDK, Building 31, Room 9A16, 31 Center Dr. MSC 2560, National Institutes of Health, Bethesda, MD 20892-2560.

Diabetes Care 1997 May; 20(5): 735-744. https://doi.org/10.2337/diacare.20.5.735

Abstract

OBJECTIVE To analyze the health benefits and economics of treating NIDDM with the goal of normoglycemia.

RESEARCH DESIGN AND METHODS Incidence-based simulation model of NIDDM was used. Hazard rates for complications were adjusted for glycemia using risk gradients from the Diabetes Control and Complications Trial. Treatment costs were estimated from national survey data and clinical trials. Incremental costs and benefits were expressed in present value dollars (3% discount rate). Life-years were adjusted for quality of life, yielding quality-adjusted life-years (QALYs).

RESULTS Comprehensive treatment of NIDDM that maintains an HbA_1c value of 7.2% is predicted to reduce the cumulative incidence of blindness, end-stage renal disease, and lower-extremity amputation by 72, 87, and 67%, respectively. Cardiovascular disease risk increased by 3% (no effect of treating glycemia is assumed). Life expectancy increased 1.39 years. The cost of treating hyperglycemia increased by almost twofold, which is partially offset by reductions in the cost of complications. The estimated incremental cost/QALY gained is $16,002. Treatment is more cost-effective for those with longer glycemic exposure (earlier onset of diabetes), minorities, and those with higher HbA_1c under standard care.

CONCLUSIONS The incremental effectiveness of treating NIDDM with the goal of normoglycemia is estimated to be ∼ $16,000/QALY gained, which is in the range of interventions that are generally considered cost-effective.