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The CDC Diabetes Cost-effectiveness Group

JAMA. 2002;287:2542-2551.

Context  Several treatment interventions can reduce complications of type 2 diabetes, but their relative cost-effectiveness is not known.

Objective  To estimate the incremental cost-effectiveness of intensive glycemic control (relative to conventional control), intensified hypertension control, and reduction in serum cholesterol level for patients with type 2 diabetes.

Design, Setting, and Patients  Cost-effectiveness analysis of a hypothetical cohort of individuals living in the United States, aged 25 years or older, who were newly diagnosed as having type 2 diabetes. The results of the United Kingdom Prospective Diabetes Study (UKPDS) and other studies were used to create a model of disease progression and treatment patterns. Costs were based on those used in community practices in the United States.

Interventions  Insulin or sulfonylurea therapy for intensive glycemic control; angiotensin-converting enzyme inhibitor or -blocker for intensified hypertension control; and pravastatin for reduction of serum cholesterol level.

Main Outcome Measures  Cost per quality-adjusted life-year (QALY) gained. Costs (in 1997 US dollars) and QALYs were discounted at a 3% annual rate.

Results  The incremental cost-effectiveness ratio for intensive glycemic control is $41 384 per QALY; this ratio increased with age at diagnosis from $9614 per QALY for patients aged 25 to 34 years to $2.1 million for patients aged 85 to 94 years. For intensified hypertension control the cost-effectiveness ratio is -$1959 per QALY. The cost-effectiveness ratio for reduction in serum cholesterol level is $51 889 per QALY; this ratio varied by age at diagnosis and is lowest for patients diagnosed between the ages of 45 and 84 years.

Conclusions  Intensified hypertension control reduces costs and improves health outcomes relative to moderate hypertension control. Intensive glycemic control and reduction in serum cholesterol level increase costs and improve health outcomes. The cost-effectiveness ratios for these 2 interventions are comparable with those of several other frequently adopted health care interventions.

Affiliations of the Members of the CDC Diabetes Cost-effectiveness Group: Thomas J. Hoerger, PhD, Albert D. Bethke, PhD, and Anke Richter, PhD, Research Triangle Institute, Research Triangle Park, NC; Stephen W. Sorensen, PhD, Michael Engelgau, MD, Ted Thompson, MS, K. M. Venkat Narayan, MD, David F. Williamson, PhD, Edward Gregg, PhD, and Ping Zhang, PhD, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Ga; Richard C. Eastman, MD, Cygnus Inc; John Fuller, MD, University College, London, England; Claire B. Gibbons, MPH, University of North Carolina School of Public Health, Chapel Hill; Steve Haffner, MD, University of Texas Health Center, San Antonio ; William H. Herman, MD, University of Michigan Medical Center, Ann Arbor; Barbara Howard, PhD, and Robert Ratner, MD, MedStar Research Institute, Washington, DC; and Trevor Orchard, MB BCh, University of Pittsburgh, Pittsburgh, Pa.

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