Model of Complications of NIDDM .2. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia

OBJECTIVE - To analyze the health benefits and economics of treating NIDDM with the goal of normoglycemia. RESEARCH DESIGN AND METHODS - Incidence-based simulation model of NIDDM was used. Hazard rates for complications were adjusted for glycemia using risk gradients from the Diabetes Control and Complications Trial. Treatment costs were estimated from national survey data and clinical trials. Incremental costs and benefits were expressed in present value dollars (3% discount rate). Life-years were adjusted for quality of life, yielding quality-adjusted life-years (QALYs). RESULTS - Comprehensive treatment of NIDDM that maintains an HbA(1c) value of 7.2% is predicted to reduce the cumulative incidence of blindness, end-stage renal disease, and lower-extremity amputation by 72, 87, and 67%, respectively. Cardiovascular disease risk increased by 3% (no effect of treating glycemia is assumed). Life expectancy increased 1.39 years. The cost of treating hyperglycemia increased by almost twofold, which is partially offset by reductions in the cost of complications. The estimated incremental cost/QALY gained is $16,002. Treatment is more cost-effective for those with longer glycemic exposure (earlier onset of diabetes), minorities, and those with higher HbA(1c) under standard care. CONCLUSIONS - The incremental effectiveness of treating NIDDM with the goal of normoglycemia is estimated to be similar to$16,000/QALY gained, which is in the range of interventions that are generally considered cost-effective.