Intensified multifactorial treatment highly cost-effective for high-risk T2D patients
Intensified multipronged treatment in patients with type 2 diabetes (T2D) for 7.8 years is not associated with any significant increase in total costs or in costs per person-year when compared to conventional multipronged treatment over a follow-up of 21.2 years, according to the results of the Steno 2 Study presented at the 78th Scientific Sessions of the American Diabetes Association (ADA 2018).
“Considering the substantial gain of years of life and health benefits achieved with intensified treatment, we conclude that intensified multifaceted intervention in high-risk patients with type 2 diabetes is highly cost-effective in a Danish healthcare setting,” researchers said.
In 1993, a total of 160 Danish patients (mean age 55 years) with T2D and microalbuminuria were randomly assigned to receive either conventional or intensified and target-driven multifactorial intervention for 7.8 years. Researchers collected data on direct health costs from health registers and evaluated any difference of costs in the two groups via nonparametric bootstrap t-test analysis.
On average, intensified treatment was more expensive in terms of drug prescriptions, but it is less expensive in terms of primary care visits (p<0.0001 for both) and inpatient admission services (p=0.02) related to cardiovascular disease (CVD; p<0.0001) during the entire follow-up period. [ADA 2018, abstract 162-OR]
No significant difference was seen in total direct medical costs between the intensified and conventional treatment groups during the entire follow-up period ($13.0 million vs $12.3 million; p=0.19). Further assessment revealed a statistically significant lower health cost per patient-year in the intensified vs the conventional treatment group ($9,648 vs $10,681 per patient; p=0.13) over 21.2 years of follow-up.
“We discovered that while intensified, multifactorial treatment may lead to an initial increase in healthcare costs, this investment is recouped over time by the impressive health benefits and increased longevity the patients experienced,” said junior lead study author Joachim Gaede, a graduate student in the medicine programme at the University of Copenhagen in Denmark.
“Additionally, the total direct costs of intensified, multifactorial intervention, which leads to disease-free-life length improvement of about 8 years, was neutral compared to conventional treatment. So, in terms of cost, investing in early-intensified intervention of all known modifiable risk factors in high-risk individuals with T2D will pay for itself over time due to a reduced cost of complications incurred by patients,” he added.
The Steno 2 Study determined whether a targeted, intensified, multifactorial therapy would have an impact on the mortality rate of T2D patients from any cause, including CVD. Danish adults with T2D and consistent microalbuminuria were enrolled. Small amounts of albumin in the urine is an indicator of generalized blood vessel damage and a strong predictor of premature, multiple organ damage.
The 1993 study showed that intensified multifactorial intervention increased median life-span by 7.9 years and delayed incident CVD by a median of 8.1 years compared to conventional intervention over the follow-up period.
“The Steno-2 trial was instrumental in establishing treatment standards for people with T2D, so it was important that we weighed the costs of the intensified multifactorial treatment recommended in the study,” Gaede said.