Abstract
Background: The economic and clinical burden of diabetes is well-established, yet a substantial proportion of people with diabetes have inadequate control of risk factors. Adherence to glycaemic, blood pressure and LDL-cholesterol targets could reduce the disease burden and save medical costs. Aim: To estimate the clinical and economic burden of diabetes associated with inadequate control of type 2 diabetes risk factors in Hong Kong over the next 10 years. Method: Population-based data of 590,008 people diagnosed with type 2 diabetes from January to December 2017 was obtained from the Hong Kong Hospital Authority electronic health records. The Hospital Authority system provides care for 95% of people with diabetes in Hong Kong. Immediate control of blood glucose, blood pressure and LDL-cholesterol (separately and combined) was compared to constant baseline levels, with outcomes projected over 10 years using the validated Chinese Hong Kong Integrated Modelling and Evaluation (CHIME) Diabetes model. Risk factor control was defined by American Diabetes Association (ADA) guidelines as glycated haemoglobin (HbA1c) targets <7% (53 mmol/mol), blood pressure <130/80 mmHg, and LDL-cholesterol <2.6 mmol/L. Quality-adjusted life years (QALYs) were calculated based on a meta-analysis of Asia-specific utility weights for diabetes and related complications. Direct medical costs were estimated from a health care provider perspective. Results: Immediate control of blood glucose, blood pressure and LDL-cholesterol was associated with population-level increases of 36,939 QALYs and 23,921 life-years with medical cost savings of USD 5.4 billion over 10 years compared to constant baseline risk levels. On an individual-level, immediate control of individual risk factors was associated with small gains of 0.06 QALYs, 0.04 life-years, and cost savings of USD 9,114 at 10 years. Among the individual risk factors, glycaemic control was associated with the greatest QALY gains and blood pressure control with the greatest medical cost savings.Tabled 1IndividualPopulationCombinedHbA1cBPLDLCombinedHbA1cBPLDLQuality-adjusted life years5 years0.020.020.010.0112,26911,4686,3915,35610 years0.060.060.040.0336,93935,71422,89220,476Life expectancy, years5 years0.010.0200.017,5488,9001,7233,49810 years0.040.050.020.0223,92127,58910,52814,475Medical cost savings, USD5 years5,1973,9014,9762,9723.1bn2.3 bn2.9 bn1.8 bn10 years9,1146,6438,5975,0545.4bn3.9 bn5.1 bn3.0 bnAbbreviations: HbA1c, glycated haemoglobin; BP, blood pressure; LDL, LDL-cholesterol, bn, billion. Open table in a new tab Abbreviations: HbA1c, glycated haemoglobin; BP, blood pressure; LDL, LDL-cholesterol, bn, billion. Discussion: The clinical and economic burden from inadequate control of risk factors in Hong Kong is substantial, particularly on a population-level. This disease burden is potentially reducible by early intervention and adherence to risk factor targets.
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