Individualizing glycemic control could reduce costs, increase quality-adjusted life-years

A cost-effectiveness analysis found that individualized control saved $13,547 per patient compared with uniform intensive control, primarily due to lower medication costs, and increased quality-adjusted life-years by 0.10.

Individualized glycemic control would be more cost-effective than universal intensive control for treating type 2 diabetes in the U.S., while slightly decreasing life expectancy and increasing quality-adjusted life-years (QALYs), a new study indicates.

Researchers applied a Markov model to data from the National Health and Nutrition Examination Survey 2011–2012 to estimate the cost-effectiveness of individualized glycemic control versus uniform intensive control (HbA1c level <7%). Results were published by Annals of Internal Medicine on Dec. 12.

The analysis found that 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). Life expectancy was reduced by 0.10 year under individualized control (20.63 years vs. 20.73 years) due to an increase in complications, but QALYs were increased by an equal amount with individualized control (16.68 QALYs vs. 16.58 QALYs) due to fewer hypoglycemic events and medications. The study authors calculated that the cost savings would add up to $234 billion when applied to the U.S. diabetes population.

“The prospect of reducing costs by using fewer medications (−0.6 per person per year) and not substantially worsening patient outcomes is appealing, especially given that many patients prefer to avoid diabetes medications if they can do so safely,” they wrote. The authors noted that intensive control may still be preferred for patients who do not mind taking diabetes medications, especially those who are ages 30 to 44 years and have complications. This subgroup of patients had lower cost savings and marginal quality-of-life benefit with individualized control, the analysis found.

Limitations of the study included the validity of the multiple assumptions needed to perform the analysis, potentially underestimating benefits of the long-term effects of early very intensive glycemic control, and the assumption that all guideline-recommended diabetes medications decreased HbA1c by 1%. The authors also noted that if future guidelines prioritize sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1–receptor agonists because they have been found to reduce cardiovascular outcomes, the higher costs of these drugs could change the calculations.