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Individualized Glycemic Control for U.S. Adults With Type 2 Diabetes: A Cost-Effectiveness Analysis. Ann Intern Med 2018 02 06;168(3):170-178



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Background: 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.

Objective: To estimate the cost-effectiveness of individualized control versus uniform intensive control (HbA1c level <7%) for the U.S. population with type 2 diabetes.

Design: Patient-level Monte Carlo-based Markov model.

Data Sources: National Health and Nutrition Examination Survey 2011-2012.

Target Population: The approximately 17.3 million persons in the United States with diabetes diagnosed at age 30 years or older.

Time Horizon: Lifetime.

Perspective: Health care sector.

Intervention: Individualized versus uniform intensive glycemic control.

Outcome Measures: Average lifetime costs, life-years, and quality-adjusted life-years (QALYs).

Results of Base-Case Analysis: Individualized control saved $13 547 per patient compared with uniform intensive control ($105 307 vs. $118 854), primarily due to lower medication costs ($34 521 vs. $48 763). 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.

Results of Sensitivity Analysis: 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%.

Limitation: The model did not account for effects of early versus later intensive glycemic control.

Conclusion: 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.

Primary Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases.

Author List

Laiteerapong N, Cooper JM, Skandari MR, Clarke PM, Winn AN, Naylor RN, Huang ES


Aaron Winn PhD Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cost Savings
Cost-Benefit Analysis
Diabetes Mellitus, Type 2
Glycated Hemoglobin A
Hypoglycemic Agents
Life Expectancy
Markov Chains
Middle Aged
Monte Carlo Method
Nutrition Surveys
Quality-Adjusted Life Years
United States
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a