Influence of Diabetes Complications on the Cost-Effectiveness of A1C Treatment Goals in Older U.S. Adults

Abstract

The American Diabetes Association (ADA) recommends glycemic management goals for older diabetes patients take into account the complexity of complications. Little information is available on how cost-effectiveness (CE) of glycemic control goals relates to a patient’s level of complications. We examined the CE of intensive glycemic control (A1c <7.5%) compared to standard treatment (A1c <8.5%) among adults aged 65 y with type 2 diabetes having various complications. 2011-2016 National Health and Nutrition Examination Survey data were used to generate nationally representative samples with various complications. The CDC-RTI diabetes simulation model was used to project the long-term health and cost consequences of intensive/standard glycemic control. The CE of the intensive glycemic control was measured in costs (2017 USD) per quality adjusted life year (QALY). Based on a $50,000/QALY threshold, intensive glycemic control was only marginally cost effective for patients with no complications or any microvascular complication (excluding renal failure) but was not cost-effective for patients with one or more macrovascular complications. Current ADA standards recommend intensive glycemic control among older adults with fewer than 3 complications. From a CE perspective, our results only support the intervention among those with no complications or only microvascular complication. Disclosure H. Shao: None. D.B. Rolka: None. E.W. Gregg: None. P. Zhang: None.