Individualized Glycemic Control for U.S. Adults With Type 2 Diabetes: A Cost-Effectiveness Analysis.

Abstract

Intensive glycemic control in type 2 diabetes (glycated hemoglobin [HbA1c] level <7%) is an established, cost-effective standard of care. However, guidelines recommend individualizing goals on the basis of age, comorbidity, diabetes duration, and complications. To estimate the cost-effectiveness of individualized control versus uniform intensive control (HbA1c level <7%) for the U.S. population with type 2 diabetes. Patient-level Monte Carlo-based Markov model. National Health and Nutrition Examination Survey 2011-2012. The approximately 17.3 million persons in the United States with diabetes diagnosed at age 30 years or older. Lifetime. Health care sector. Individualized versus uniform intensive glycemic control. Average lifetime costs, life-years, and quality-adjusted life-years (QALYs). Individualized control saved $13547 per patient compared with uniform intensive control ($105307 vs. $118854), primarily due to lower medication costs ($34521 vs. $48763). Individualized control decreased life expectancy (20.63 vs. 20.73 years) due to an increase in complications but produced more QALYs (16.68 vs. 16.58) due to fewer hypoglycemic events and fewer medications. Individualized control was cost-saving and generated more QALYs compared with uniform intensive control, except in analyses where the disutility associated with receiving diabetes medications was decreased by at least 60%. The model did not account for effects of early versus later intensive glycemic control. Health policies and clinical programs that encourage an individualized approach to glycemic control for U.S. adults with type 2 diabetes reduce costs and increase quality of life compared with uniform intensive control. Additional research is needed to confirm the risks and benefits of this strategy. National Institute of Diabetes and Digestive and Kidney Diseases.