Evaluating the Long-Term Health Economic Implications of Improving the Proportion of Patients with Type 2 Diabetes Meeting Treatment Targets in Mexico

Abstract

ObjectivesTo analyze the health economic implications of increasing the proportion of patients with type 2 diabetes meeting treatment targets for glycemia, blood pressure, and serum lipid levels in Mexico. MethodsComplication rates, life expectancy, quality-adjusted life expectancy, and costs were projected over patient lifetimes using a published and validated diabetes model (with outcomes discounted at 5% annually). Baseline cohort characteristics were derived from the Mexican cohort of A1chieve. Scenarios in which 20% to 80% of the patients achieved glycemic targets (glycosylated hemoglobin [HbA1c] level of 7%) only, or blood pressure and lipid targets (based on international guidelines) in addition to glycemic targets were compared with current standard of care. ResultsIncreasing the proportion of patients meeting Hb A1c targets was projected to increase mean life expectancy and quality-adjusted life expectancy by up to 0.60 years and 0.34 quality-adjusted life-years over current care. When patients achieved all treatment targets, clinical benefits were greater than when only the Hb A1c level was controlled. Increasing the proportion of patients reaching the glycemic target was projected to lead to cost savings over conventional treatment, reducing mean costs by up to Mexican pesos 42,389 (US $3314). Surprisingly, bringing patients to other targets, as well as the Hb A1c target, did not result in greater cost savings. This was as a result of the increased life expectancy in these simulations, leading to greater costs in the final years (survival paradox). ConclusionsIncreasing the proportion of patients achieving treatment targets resulted in improved clinical outcomes and cost savings from a health care payer perspective in Mexico.