Table 1

Description of the cost-effectiveness studies for diabetes interventions*

Source/study quality/countryStudy populationInterventionComparisonEffectiveness dataMethodology/analytical horizon/discount rateCost-effectiveness ratios (2007 U.S. $)
Preventing type 2 diabetes among high-risk individuals
    Segal et al. 1998 (59)§ AustraliaSeriously obese or seriously obese with IGTIntensive diet and educationStandard careLiterature review25 years 5%Cost saving
Overweight or obese IGT or NGT and IGTGroup education in workplace on diet and physical activity for menStandard careCost saving
High-risk adults IGT or NGT and IGTGeneral practitioner advice on healthy lifestyleStandard care$1,000–$2,500/LYG
Overweight adults in general populationCommunity-supported media campaign on obesity/sedentary lifestyleNo campaignCost saving
Women with GDM history + NGT or IGTIntensive diet and behavioral modificationStandard care$1,300–$2,500/LYG
    DPP 2003 (66) U.S.IGTIntensive lifestyle modificationStandard advice on lifestyleDPP Multicenter RCT (n = 3,234)3 years 0%$32,900/QALY; if in 10-person group, $11,100/QALY
IGTMetforminStandard advice on lifestyle$134,000/QALY; if metformin cost reduced 50%, $76,500/QALY
IGTIntensive lifestyle modification‡‡Standard advice on lifestyle$69,400/QALY; if in 10-person group, $36,000/QALY
IGTMetformin‡‡Standard advice on lifestyle$133,400/QALY
    Caro et al. 2004 (15) CanadaIGTIntensive lifestyle modificationNo interventionDPP (n = 3,234), FDPS (n = 52)10 years 5%$700/LYG
IGTMetforminNo interventionCost saving in LYG and QALY
    Palmer et al. 2004 (50) Australia, France, Germany, Switzerland, U.K.IGTIntensive lifestyle modificationStandard advice on lifestyleDPP Multicenter RCT (n = 3,234)Lifetime 5% except U.K.: cost 5%, effectiveness, 1.5%Cost saving except U.K.; U.K.: $8,300/LYG
IGTMetforminStandard advice on lifestyleCost saving, except UK; UK: $6,500/LYG
    Eddy et al. 2005 (25) U.S.IGTIntensive lifestyle modification‡‡No interventionDPP Multicenter RCT (n = 3,234)30 years 3%$84,700/QALY; in 10-person group, $16,000/QALY
IGTIntensive lifestyle modification#No intervention$192,600/QALY; in 10-person group, $36,400/QALY
IGTMetformin‡‡No intervention$47,900/QALY
    Herman et al. 2005 (34) U.S.IGTIntensive lifestyle modificationStandard advice on lifestyleDPP Multicenter RCT (n = 3,234)Lifetime 3%$1,500/QALY; in 10-person group, cost saving
Intensive lifestyle modification‡‡Standard advice on lifestyle$11,800/QALY
MetforminStandard advice on lifestyle$42,000/QALY
GenericStandard advice on lifestyle$2,400/QALY
Metformin‡‡$40,200/QALY
    Lindgren et al. 2007 (41) SwedenIGT Age 60 years BMI >25 kg/m2, FPG >6.1 mmol/lIntensive lifestyle intervention (6 years)‡‡General lifestyle adviceFDPS (n = 52)Lifetime 3%Cost saving not considering cost of extended life; $2,600/QALY including cost of extended life
    Hoeger et al. 2007 (36) U.S.U.S. population age 45–74 years, overweight and obese (BMI ≥ 25 kg/m2) GroupsScreening for IGT and IFPG, DPP lifestyle intervention with IGT + IFPGNo screening and no lifestyle interventionDPP (n = 3,234)Lifetime 3%$10,600/QALY; in group settings, cost saving
Screening for IGT and IFPG, DPP lifestyle intervention with IFPG or IGT + IFPGNo screening and lifestyle intervention$12,300/QALY; in group settings, $344/QALY
Screening for IGT and IFPG, DPP lifestyle intervention with IGT + IFPGScreening for IGT and IFPG, following DPP lifestyle intervention with IFPG, IGT, or IFPG + IGT$13,100/QALY
Screening and metformin treatment with IGT + IFPGNo screening and treatment$26,600/QALY
Screening and metformin treatment with IGT, IFPG, or IGT + IFPGNo screening and treatment$26,000/QALY
Screening for undiagnosed type 2 diabetes and gestational diabetes
    Centers for Disease Control and Prevention 1998 (16) U.SU.S. population 25 years and older One-timeOpportunistic screening for undiagnosed type 2 diabetes starting at age 25 years, then treatment (universal screening)No screening and treatment until clinical diagnosis of type 2 diabetesLifetime 3%$374,900/LYG or $89,800/QALY; increasing with age (age ≥ 25 years) treatment (universal screening)
     .$57,100/LYG or $21,400/QALY (age 25–34 years)
$103,200/LYG or $29,700/QALY (age 35–44 years)
293,900/LYG or $70,100/QALY (age 45–54 years)
$1 million/LYG or $185,000/QALY (age 55–64 years)
$928,000/QALY (age ≥65)
African Americans:
    age 25–34 years$3,500/LYG or $1,300/QALY
    age 35–44 years$10,200/LYG or $3,100/QALY
    age 45–54 years$95,400/LYG or $19,600/QALY
    age 55–64 years$764,100/LYG or $112,600/QALY
    age ≥65 years$2 million/LYG or $500,000/QALY
    Hoerger et al. 2004 (35) U.S.Persons with hypertensionTargeted screening for undiagnosed diabetes among persons with hypertensionNo screening or treatment until clinical diagnosis of type 2 diabetesLifetime 3%$46,800–$130,500/QALY decreasing with age $70,500/QALY for age 45 years
U.S. populationOne-time opportunistic screening, then treatment (universal screening)No screening or treatment until clinical diagnosis of type 2 diabetes$72,200–$189,100/QALY decreasing with age $183,500/QALY for age 45 years
U.S. populationOne-time opportunistic screening, then treatment (universal screening)Targeted screening, then treatment$215,600–$699,800/QALY increasing with age
    Nicolson et al. 2005 (44) U.S.30-year-old pregnant women between 24–28 weeks' gestationSequential method (50-g GCT + 100-g GTT)‡‡No screening 75-g GTTA few unidentified RCTs<1 year** 0%Cost saving
100-g GTT‡‡No screening or 75-g GTT methodCost saving
100-g GTT‡‡Sequential method$35,200/QALY for maternal outcomes, $9,000/QALY for neonatal outcomes
Intensive glycemic control
    DCCT 1996 (65) U.S.Type 1 diabetesIntensive glycemic control through insulin management, self-monitoring, and outpatient visits. The goal was to achieve A1C level as normal as possible (6%)Conventional therapy (less intensive)DCCT Multicenter RCT (n = 1,441)Lifetime 3%$47,600/life year gained, $50,800/QALY
    Palmer et al. 2000 (46) SwitzerlandType 1 diabetesIntensive insulin therapyConventional insulin therapyLiterature reviewLifetime 3%, 5%, 6% Reported results at 3% in the table$46,600/LYG
    Scuffham et al. 2003 (58) U.K.Type 1 diabetesContinous subcutaneous insulin intervention for persons using insulin pumpMultiple daily insulin injections1 systematic review 1 meta-analysis8 years 6%$10,200/QALY
    Roze et al. 2005 (56) U.K.Type 1diabetesContinuous subcutaneous insulin infusionMultiple daily insulin injectionsDCCT (n = 1,441) mainly meta-analysis60 years 3%$18,500/QALY
    Eastman et al. 1997 (24) U.S.Newly diagnosed type 2 diabetesIntensive treatment targeting maintenance of A1C level at 7.2%Standard antidiabetic treatment targeting A1C level at 10%DCCT (n = 1,441)Lifetime 3%$17,400/QALY; sensitive to age at diabetes onset; CER <33,000 for age <50 years; $371,700/QALY for age 70–80 years
    Gray et al. 2000 (30) U.K.Type 2 diabetesIntensive management with insulin or sulfonylurea aiming at FPG <6 mmol/lConventional management (mainly through diet) aiming at FPG <15 mmol/lUKPDS Multicenter RCT (n = 5,120)10 years** 6%Cost saving in trial; $1,100/event-free year gained in clinic setting
    Wake et al. 2000 (70) JapanType 2 diabetesIntensive insulin therapy through multiple insulin injections A1C <7%Conventional insulin injection therapyKumamoto study RCT (n = 110)10 years** 3%Cost saving
    Clarke et al. 2001 (18) U.K.Newly diagnosed type 2 diabetes OverweightIntensive blood glucose control with metformin aiming at FPG <6 mmol/lConventional treatment primarily with dietUKPDS (n = 5,120)Median 10.7 years** 6%Cost saving
    Centers for Disease Control and Prevention 2002 (17) U.S.Newly diagnosed type 2 diabetesIntensive glycemic control with insulin or sulfonylurea aiming at FPG of 6 mmol/lConventional glucose control (mainly diet)UKPDS (n = 5,120)Lifetime 3%$62,000/QALY; increasing rapidly with age at diagnosis: $14,400/QALY for age 25–34 years; $27,500–$56,000/QALY for age 35–54 years; > $100,000–$3.1 million for age 55–94 years
Cost saving under UKPDS cost scenario (no case management cost, much less self-testing, slightly fewer physician visits) but using U.S. unit cost
    Clarke et al. 2005 (19) U.K.Newly diagnosed type 2 diabetes requiring insulinIntensive glycemic control with insulin or sulfonylurea at FPG <6 mmol/lConventional glucose control therapy (mainly diet)UKPDS (n = 5,120)Lifetime 3.5%$3,400/QALY
Newly diagnosed type 2 diabetes OverweightIntensive glycemic control with metforminConventional glucose control therapy (mainly diet)Cost saving
Eddy et al. 2005 (25) U.S.Newly diagnosed type 2 diabetesIntensive DPP lifestyle with FPG >125 mmol/l Target: A1C level of 7% ‡‡Dietary adviceDPP (n = 3,234)30 years 3%$33,100/QALY
    Almbrand et al. 2000 (13) SwedenType 2 diabetes with acute MIInsulin-glucose infusion for at least 24 h, then subcutaneous multidose insulin for ≥3 monthsStandard antidiabetic therapyDIGAMI study, RCT 1-year intervention, 4-year follow-up (n = 620)5 years** 3%$8,700/LYG, $12,400/QALY
Self-monitoring blood glucose
    Tunis 2008 (67) U.S.Type 2 diabetes treated with oral agents in a large HMOSMBG 1 time/day 40-year horizon public payerNo SMBGKaiser Permanente longitudinal study of cohort of “new antidiabetic drug users”40 years 3%$8,200/QALY; 52.6% probability less than $50,000/QALY
SMBG 3 times/day 40-year horizonNo SMBG$6,900/QALY; 60.7% probability less than $50,000/QALY
SMBG 1 time/day 5-year horizon 10-year horizonNo SMBG$24,200/QALY
$9,700/QALY
SMBG 3 times/day 5-year horizon 10-year horizonNo SMBG$30,300/QALY
$540/QALY
Intensive hypertension control
    UKPDS 1998 (68) U.K.Type 2 diabetes HypertensionTight control of hypertension, BP <150/<80 mmHg, ACE inhibitor, β-blocker, and other agentsLess tight control of BP (mmHg), Initially <200/105, Later 180/105UKPDS (n = 5,120)Lifetime 6%Cost saving in trial; $960/year free from occurrence of diabetes endpoint in clinic
    Elliot et al. 2000 (26) U.S.Type 2 diabetes Hypertension, initially free of CVD or ESRDReduction of BP to 130/85 mmHg Medications not mentionedReduction of BP to 140/90 mmHgMeta-analysis of data from epidemiological studies and clinical trialsLifetime 3%
Start of treatment
Age 50 years$1,200/LYG
Age 60 yearsCost saving
Age 70 yearsCost saving
    Centers for Disease Control and Prevention 2002 (17) U.S.Type 2 diabetes HypertensionIntensified hypertension control ACE inhibitor β-blocker Average BP 144/82 mmHgModerate hypertension control, Average BP 154/86 mmHgUKPDS (n = 5,120)Lifetime 3%Cost saving
    Clarke et al. 2005 (19) U.K.Type 2 diabetes HypertensionTight BP control BP <150/85 mmHg, ACE inhibitor (captopril) or β-blocker (atenolol)Less tight control of BP (mmHg), Initial <200/105, Later <180/105UKPDS (n = 5,120)Lifetime 3.5%$200/QALY
Cholesterol control
    Herman et al. 1999 (33) U.S.Type 2 diabetes Dyslipidemia, Previous MI or anginaSimvastatinPlacebo4S study, Double-blind randomized, placebo-controlled, multicenter, multicountry trial (n = 4,444)5 years** 3% for cost, 0% for benefitCost saving
    Jonsson et al. 1999 (39) European countriesType 2 diabetes Dyslipidemia, Previous MI or anginaSimvastatinPlacebo4S study (n = 4,444)Lifetime 3%CS-$9,400/LYG in different countries, Median: $2,800/LYG
    Grover et al. 2000 (31) CanadaType 2 diabetes Dyslipidemia CVD history, Men and women 60 years oldSimvastatinPlacebo4S study (n = 4,444) CARE (n = 4,159)Lifetime 5%$6,100–$12,300/LYG Increasing with pretreatment of LDL cholesterol level
Type 2 diabetes Dyslipidemia, No CVD historySimvastatinPlacebo
Men Pretreatment LDL cholesterol level:
5.46 mmol/l (211 mg/dl)$6,100–$15,000/LYG
3.5 mmol/l (135 mg/dl)$10,700–$23,000/LYG
Women Pretreatment LDL cholesterol level:
5.46 mmol/l$15,300–$27,600/LYG
3.5 mmol/l$36,800–$61,300/LYG
    Centers for Disease Control and Prevention 2002 (17) U.S.Type 2 diabetes Dyslipidemia, No CVD historyPravastatinPlaceboWest Scotland Coronary Prevention Study (n = 6,595 men)Lifetime 3%U-shape for age, $77,800/QALY
    Raikou et al. 2007 (54) U.K. IrelandType 2 diabetes, No CVD history, No elevated LDL cholesterol level ≥1 CVD risk factor: retinopathy, microalbuminuria or macroalbuminuria, current smoking, or hypertensionAtorvastatinPlaceboCARDS, Randomized, controlled, multicenter trial 94% white (n = 2,838)Lifetime 3.5%$2,800/LYG, $3,500/QALY Using UKPDS risk engine Low risk: $11,300/QALY; Medium risk: $4,700/QALY; High risk: $2,200/QALY
Smoking cessation
    Earnshaw et al. 2002 (23)Newly diagnosed type 2 diabetesSmoking cessation, Standard antidiabetic careStandard antidiabetic careLifetime 3%
        United StatesSmokers
Aged 25–84 years<$25,000/QALY
Aged 85–94 years$89,800/QALY
Educational program
    Shearer et al. 2004 (61)§ GermanyType 1 diabetesStructured treatment and teaching program: educational course of training to self-manage diabetes and enjoy dietary freedomUsual care (daily insulin injection)Rosiglitazone trial CODE2 study of prevalence of complications, not an RCTLifetime 6%Cost saving
    Gozzoli et al. 2001 (29) SwitzerlandType 2Standard antidiabetic care plus educational program, Self-monitoring, Recommendations on diet and exercise, Self-management of diabetes and complications, General health educationStandard antidiabetic careLiterature review (quality)Lifetime 3%$4,000/LYG
Diabetes disease management
    Mason et al. 2005 (43) EnglandType 2 diabetes HypertensionPolicy to implement clinics led by specialist nurses to treat and control hypertension through consultation, medication review, condition assessment, and lifestyle adviceUsual careSPLINT RCT (n = 1,407) UKPDS (n = 5,120)Lifetime 5%$4,800/QALY
Diagnosed diabetes DyslipidemiaPolicy to implement clinics led by specialist nurses to treat and control hyperlipidemia by usual careUsual care$23,600/QALY
    Gilmer et al. 2007 (27) San Diego County, CaliforniaDiabetes 48% LatinosCulturally sensitive case management and self-management training program led by bilingual/bicultural medical assistant and registered dietitian stepped-care pharmacologic management of glucose and lipid levels and hypertension‡‡‡Standard careProject Dulce Observational cohort study with controls Average follow-up, 289 days (n = 3,893)40 years 3%$9,400/LYG or $12,000/QALY for uninsured; 100% probability to be less than $50,000 and $100,000/QALY, respectively
$22,400/LYG or $29,100/QALY for patients in County Medical Services;
92% or 98% probability to be cost-effective if willingness to pay was $50,000 or $100,000/QALY, respectively
$42,600/LYG or $53,120/QALY for patients in Medi-Cal;
57% or 81% probability to be cost-effective if willingness to pay was $50,000 and $100,000/QALY, respectively
$68,400/LYG or $82,300/QALY for patients with commercial insurance;
31% and 62% probability to be cost-effective if willingness to pay was $50,000 and $100,000/QALY, respectively
Preventing diabetic complications Eye complications
    Javitt et al. 1994 (37)§ U.S.Newly diagnosed type 2 diabetes8 strategies for eye screening with dilation: Screening every 1, 2, 3, or 4 years andNo screeningCross-sectional and longitudinal studiesLifetime 5%All 8 strategies were cost saving
More frequent follow-up screening for diabetes patients with background retinopathy††
Javitt et al. 1996 (38) U.S.Newly diagnosed type 1 and type 2 diabetesAnnual eye screening with dilation for all patients with diabetes but no retinopathyEye screening in 60% of diabetes patientsCross-sectional and longitudinal studiesLifetime 5%$3,800/person-year of sight saved, $6,900/QALY
Type 1 diabetes$4,300/QALY
Type 2 diabetesExamination every 6 months for those with retinopathy$6,900/QALY
    Palmer et al. 2000 (46) SwitzerlandType 1 diabetesAnnual eye screening and treatment, Conventional insulin therapyConventional insulin therapyLiterature reviewLifetime 3%Cost saving
    Vijan et al. 2000 (69) U.S.Type 2Eye screening for diabetes patients every 5 years Subsequent annual screening for those with background retinopathyNo screeningEpidemiological studiesLifetime 3%$23,500/QALY
Eye screening for diabetes patients every 3 years Subsequent annual screening for those with background retinopathyNo screening$27,000/QALY
Eye screening for diabetes patients every 2 years Subsequent annual screening for those with background retinopathyNo screening$30,700/QALY
Eye screening annually for diabetes patients Subsequent annual screening for those with background retinopathyNo screening$39,500/QALY
Eye screening for diabetes patients every 3 years5-year intervals$32,800/QALY
Eye screening for diabetes patients every 2 years3-year intervals$54,000/QALY
Annual eye screening for diabetes patients2-year intervals$116,800/QALY
    Maberley et al. 2003 (42) Western James Bay, Victoria, British Columbia, CanadaType 1 diabetes and Type 2 diabetesScreening using digital camera Immediate assessment of quality or electronically transferred to a remote reading centerRetina specialists visit Moose Factory every 6 months to examine people with diabetes, and patients in outlying communities are flown to Moose Factory, Canada10 years 5%Cost saving
Foot ulcers
    Tennval et al. 2001 (64) SwedenType 1 diabetes and Type 2 diabetesOptimal prevention of foot ulcer including foot inspection, appropriate footwear, treatment, and educationUsual careClinical and epidemiological data5 years** 0%
High risk: Previous foot ulcer Previous amputationCost saving
Moderate risk: Neuropathy, PVD, and/or foot deformityCost saving
Low risk: No specific risk factor>$100,000/QALY
    Ortegon et al. 2004§ (45) The NetherlandsNewly diagnosed type 2 diabetesIntensive glycemic control Optimal foot careStandard careUKPDS (n = 5,120)Lifetime 3%$44,900/QALY
Foot ulcerLiterature review on trials and epidemiological studiesAssuming 10% reduction of foot lesion, $308,300/QALY
Assuming 90% reduction of foot lesion, $17,000/QALY
Intensive glycemic control plus optimal foot careStandard careAssuming 10% reduction of foot lesion, $34,400/QALY
Assuming 90% reduction of foot lesion, $11,010/QALY
End-stage renal disease
    Borch-Johnsen et al. 1993 (14)§ GermanyType 1 diabetesAnnual screening for microalbuminuria at 5 years after diabetes onset, ACEI treatmentTreatment of macroalbuminuriaDanish cohort (n = 2,890)30 years 6%Cost saving
    Kiberd et al. 1996 (40)§ CanadaType 1 diabetesScreening for microalbuminuria ACEI treatmentTreatment of hypertension and/or macroproteinuriaClinical trialLifetime 5%$58,400/QALY
    Palmer et al. 2000 (46) SwitzerlandType 1 diabetes High total cholesterol level High systolic BPMicroalbuminuria monitoring, ACE treatment, Conventional insulin therapyConventional insulin therapyLiterature reviewLifetime 3%Cost saving
    Dong et al. 2004 (22) U.S.Type 1 diabetesACEI treatment starting at 1 year after diagnosisAnnual screening for microalbuminuria ACE treatmentDCCT (n = 1,441)Lifetime 3%$38,000/QALY, Increased with lowering A1C level; at A1C level 9%, <25,000/QALY
    Sakthong et al. 2001 (57)§ ThailandType 2 diabetes Microalbuminuria but normal BPACE inhibitorsPlacebo7-year RCT in Israel (n = 94)25 years 8%Cost saving
    Souchet et al. 2003 (62) FranceType 2 diabetes NephropathyLosartanPlaceboRENAAL study Multicenter international trial (n = 1,513)4 years** Cost discounted at 8% Benefits not discountedCost saving
    Szucs et al. 2004 (63)§ SwitzerlandType 2 diabetes NephropathyLosartanPlaceboRENAAL study Multicenter international trial (n = 1,513)3.5 years** 0%Cost saving
    Palmer et al. 2003 (47) Belgium, FranceType 2 diabetes Macroalbuminuria HypertensionIrbesartanStandard therapy for hypertensionIDNT study Multicenter, double-blind placebo controlled trial (n = 1,715)Lifetime 3%Cost saving
    Palmer et al. 2004 (49) U.K.Type 2 diabetes Hypertension NephropathyIrbesartanStandard therapy for hypertensionIDNT study (n = 1,715)10 years 6% for costs 1.5% for benefitsCost saving
    Palmer et al. 2005 (51) SpainType 2 diabetes Microalbuminuria HypertensionIrbesartanStandard therapy for hypertension, No ACEI, AIIRA, or β-blockersIDNT study (n = 1,715) IRMA-2 trial Randomized controlled study (n = 582)25 years 3%Cost saving
    Palmer et al. 2007 (52) HungaryType 2 diabetes MicroalbuminuriaAdding irbesartanPlacebo + standard therapy for hypertensionIDNT study (n = 1,715) IRMA-2 trial (n = 582)25 years 5%Cost saving
    Palmer et al. 2004 (48) U.S.Type 2 diabetes HypertensionIrbesartan at stage of microalbuminuriaStandard therapy for hypertensionIDNT study (n = 1,715)25 years 3%Cost saving
MicroalbuminuriaIrbesartan at stage of macroalbuminuriaStandard therapy for hypertensionCost saving
Irbesartan at stage of microalbuminuriaIrbesartan at stage of macroalbuminuriaCost saving
    Palmer et al. 2007 (53) U.K.Type 2 diabetes HypertensionIrbesartan at stage of microalbuminuriaStandard therapy for hypertensionIDNT study (n = 1,715) IRMA-2 trial (n = 582)25 years 3.5%Cost saving
MicroalbuminuriaIrbesartan at stage of macroalbuminuriaStandard therapy for hypertensionCost saving
Irbesartan at stage of microalbuminuriaIrbesartan at stage of macroalbuminuriaCost saving
    Coyle et al. 2007 (21) CanadaType 2 diabetes Hypertension Macronephropathy or MicronephropathyIrbesartan added at stage of microalbuminuriaConventional treatment for diabetes and hypertension, No ACEI or AIIRAsIDNT study (n = 1.715) IRMA-2 trial (n = 582)Lifetime 5%Cost saving
Irbesartan added at stage of overt nephropathyConventional treatment for diabetes and hypertensionCost saving
Irbesartan added at stage of microalbuminuriaIrbesartan added at stage of overt nephropathyCost saving
    Golan et al. 1999 (28) U.S.Newly diagnosed type 2 diabetesTreat patients with new diagnosis with ACEIScreening for macroalbuminuria and treatment with ACEIU.S.-Canada Collaborative study for type 1 diabetes, RCT (n = 207) 2 RCT for type 2 diabetes in Israel (n = 94 and 156, respectively)Lifetime 3%Cost saving
Screening for microalbuminuria and treatment with ACEIScreening for macroalbuminuria and treatment with ACEICost saving
Treat patients with new diagnosis with ACEIScreening for microalbuminuria and treatment with ACEI$10,900/QALY
Clarke et al. 2000 (20) CanadaType 1 diabetesProvince or territory paying for ACEIPay from out-of-pocketCollaborative observational study using administrative data base (N=8.4 million)21 years 5%Cost saving
Compliance rate and cost of ACEI affected ICER greatly
Rosen et al. 2005 (55) USMedicare population Type 1 and type 2 diabetesMedicare full-payment for ACEIPay from out-of-pocketHOPE TrialLifetime 3%Cost saving if ACEI use increased by at least 7.2%
Medicare paying for ACEICurrent Medicare Modernization ActMultinational RCTIf use increased by 2.9%, <$20,000/QALY
Cost saving if ACEI use increased by at least 6.2%
If use increased by 2.2%, <$20,000/QALY
Comprehensive interventions
    Palmer et al. 2000 (46) SwitzerlandType 1 diabetesC + ACEI therapy + eye screening and treatment (EYE)Conventional glycemic control (C)Literature reviewLifetime 3%Cost saving
        Intensive insulin therapy (I) + ACEI therapyI$46,500/LYG
I + EYEI$50,600/LYG
I + ACEI therapy + EYEI$49,800/LYG
    Gozzoli et al. 2001 (29) SwitzerlandType 2 diabetesAdded education program, nephropathy screening, and ACEI therapy to standard antidiabetic careStandard antidiabetic careLiterature reviewLifetime 0%, 3%Cost saving
Added education program, nephropathy screening, ACEI therapy, and retinopathy screening and laser therapy to standard antidiabetic careStandard antidiabetic careCost saving
Multifactorial intervention included educational program, screening for nephropathy and retinopathy, control of CVD risk factors, early diagnosis and treatment of complications, and health educationStandard antidiabetic careCost saving
Treatment of diabetes-related complications Retinopathy
    Sharma et al. 2001 (60) U.S.Diabetic retinopathy Health maintenance organizationImmediate vitrectomy for management of vitreous hemorrhage secondary to diabetic retinopathyDeferral of vitrectomyDRVSLifetime 6%$2,900/QALY
Foot ulcer
    Habacher et al. 2007 (32) AustriaNewly diagnosed diabetic foot ulcerIntensified treatment by international consensus on diabetic foot careStandard treatmentRetrospective study of patient records on 119 consecutive ulcerations in 86 patients at tertiary outpatient clinic specializing in treatment of diabetic foot ulcers15 years 0–8%Cost saving
  • 4S, Scandinavian Simvastatin Survival Study; ACEI, angiotensin converting enzyme inhibitors; AHT, arterial hypertension; AIIRA, angiotensin II receptor antagonists; BP, blood pressure; C, conventional glycemic control; CAD, coronary artery disease; CARDS, Collaborative Atorvastatin Diabetes Study; CARE, Cholesterol and Recurrent Events; CDC, Centers for Disease Control and Prevention; CODE2 = the cost of diabetes type 2 in Europe; CORE, Center for Outcomes Research; CVD, cardiovascular disease; DAIS, Diabetes Atherosclerosis Intervention Study; DCCT, Diabetes Control and Complications Trial; DIGAMI, Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction; DiGEM, diabetes glycemic education and monitoring; DPN, diabetic peripheral neuropathy; DPP, diabetes prevention program; DRVS, Diabetic Retinopathy Vitrectomy Study; DTTP, diabetes treatment and teaching program; EYE, screening for retinopathy and ensuing treatment; FDPS, Finish Diabetes Prevention Study; FPG, fasting plasma glucose; HMO, Health Maintenance Organization; HOPE, Heart Outcome Prevention Evaluation; I, intensive glycemic control; ICER, incremental cost effectiveness ratio; IDNT, Irbesartan Type II Diabetic Nephropathy Trial; IFPG, impaired fasting plasma glucose; IGT, impaired glucose tolerance; IMPACT, Improving Mood-Promoting Access to Collaborative Treatment; KORA, Cooperative Research in the Region of Augsburg; MI, myocardial infarction; NGT, normal glucose tolerance; NIDDM, Non-Insulin Dependent Diabetes Mellitus; OGTT, oral glucose tolerance test; PHN, postherpetic neuralgia; PROactive, PROspective pioglitAzone Clinical Trial in macroVascular Events; PROPHET, Prospective Population Health Event Tabulation; PVD, peripheral vascular disease; RCT, randomized clinical trial; RENAAL, Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan; ROSSO, RetrOlective Study Self-Monitoring of Blood Glucose and Outcome; RPG, random plasma glucose; SMBG, self-monitoring blood glucose; SPECT, single proton emission computed tomography; SPLINT, specialist nurse-led intervention to treat and control hypertension and hyperlipidemia in diabetes; QALY, quality adjusted life year; VA-HIT, VA-HDL Intervention Trial.

  • *The studies were ordered by grouping similar interventions together, then follow the year and alphabetical order of the first author's last name; the numbers in the parenthesis are the reference number.

  • †The study was rated as “excellent” quality unless otherwise indicated.

  • §The study was rated as “good” quality.

  • ‖The study is based on simulation modeling unless otherwise indicated.

  • **Within trial or within epidemiological study.

  • ‡The study was done from the perspective of the health system unless otherwise indicated.

  • ‡‡The study was done from the societal perspective.

  • #The study done from the perspective of the health plan.

  • ††The study was done from the federal budget perspective.

  • †††Third party payer perspective.