Intensive blood glucose control is cost-effective in type 2 diabetics
Från BMJ 2000;320:1373-137

Intensive blood glucose control in type 2 diabetics costs more than conventional therapy, but provides savings in the form of reduced complications, according to a report in the May 20th issue of the British Medical Journal. Dr. Alastair Gray, of the University of Oxford, in Headington, UK, and colleagues used data from the 10-year United Kingdom Prospective Diabetes Study to evaluate the cost-effectiveness of intensive blood glucose control (maintaining fasting blood glucose below 6 mmol/L) compared with conventional control (maintaining fasting blood glucose below 15 mmol/L) in 3,867 patients with newly diagnosed type 2 diabetes.

    The intensive blood glucose control patients received either insulin or sulfonylurea drugs. The average incremental cost of intensive anti-diabetic treatment, compared with conventional management, was 659 British pounds sterling, the authors report. In contrast, the mean cost of hospital admissions was higher for the conventional management group (4,266 pounds versus 3,494 pounds for the intensive control group), largely because of longer lengths of stay and slightly higher numbers of admissions.

    The reduced cost of complications (hospitalizations) in the intensive control group counterbalanced the increased cost of treatment, the investigators note, resulting in insignificant differences in total costs between the two treatment approaches. These comparisons held when insulin and sulfonylurea therapies were analyzed separately. Cost-effectiveness was evaluated using the incremental cost per year of event-free survival, the report indicates. Discounting the costs at 6% per year and leaving the effects undiscounted, the authors arrive at a cost of 563 pounds per event-free year gained.

   - With costs and effects discounted at 6% a year, they add, there is a 10% probability that intensive blood glucose control policy would prove to be cost saving compared with a conventional policy, a 50% probability that the cost per event-free year lies above (or below) the point estimate of 1,166 pounds, and an 80% probability that the ratio is less than 2,500 pounds.
   - Our results suggest that intensive management of patients with type 2 diabetes is a feasible and economically supportable option, the authors conclude.

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