Impact of achieving primary care targets in type 2 diabetes on health outcomes and healthcare costs.

Abstract

In England and Wales, the National Diabetes Audit (NDA) assesses the quality of management of type 2 diabetes (T2D) in primary care using treatment targets for HbA1c ≤58 mmol/mol, total cholesterol <5 mmol/L and blood pressure ≤140/80 mm Hg. We quantified the impact of variation in achieving these targets on health outcomes and healthcare costs across general practitioners' (GP) practices. Summary of characteristics of T2D patients from the 2015-2016 NDA were used to generate representative populations of T2D patients. The UKPDS Outcomes Model 2 was used to estimate long-term health outcomes and healthcare costs. The effects of achieving treatment targets on these outcomes were evaluated using regression models. Achieving more of the HbA1c, cholesterol and blood pressure targets led to a lower incidence of diabetes-related complications. Approximately 0.5 (95% CI, 0.4-0.6) quality-adjusted life years (QALYs) and 0.6 (95% CI, 0.4-0.7) years of life (LYs) were gained by T2D patients over a lifetime for each additional target met. The projected healthcare cost savings arising from fewer diabetes-related complications as the result of achieving one, two or three targets compared to none were £859 (95% CI, £553-£1165), £940 (95% CI, £485-£1395) and £1037 (95% CI, £414-£1660) over a patient's lifetime. A typical GP practice in the lowest performing decile (average, 371 T2D patients per practice, with 27% achieving all targets) is projected to gain 201 (95% CI, 123-279) QALYs and 231 (95% CI, 133-329) LYs, if all T2D patients achieved all three targets. Substantial gains in health outcomes and reductions in healthcare costs could be achieved with further improvements in attainment of HbA1c, cholesterol and blood pressure targets for T2D patients.