Econstudentlog

Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review

Here’s the link. If you have any interest in this subject, you should probably read all of it.

“We conducted a systematic review of literature on the CE of diabetes interventions recommended by the American Diabetes Association (ADA) and published between January 1985 and May 2008. We categorized the strength of evidence about the CE of an intervention as strong, supportive, or uncertain. CEs were classified as cost saving (more health benefit at a lower cost), very cost-effective (≤$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001 to $50,000 per LYG or QALY), marginally cost-effective ($50,001 to $100,000 per LYG or QALY), or not costeffective (>$100,000 per LYG or QALY). The CE classification of an intervention was reported separately by country setting (U.S. or other developed countries) if CE varied by where the intervention was implemented. Costs were measured in 2007 U.S. dollars.

RESULTS— Fifty-six studies from 20 countries met the inclusion criteria. A large majority of the ADA recommended interventions are cost-effective. We found strong evidence to classify the following interventions as cost saving or very cost-effective: (I) Cost saving — 1) ACE inhibitor (ACEI) therapy for intensive hypertension control compared with standard hypertension control; 2) ACEI or angiotensin receptor blocker (ARB) therapy to prevent end-stage renal disease (ESRD) compared with no ACEI or ARB treatment; 3) early irbesartan therapy (at the microalbuminuria stage) to prevent ESRD compared with later treatment (at the macroalbuminuria stage); 4) comprehensive foot care to prevent ulcers compared with usual care; 5) multi-component interventions for diabetic risk factor control and early detection of complications compared with conventional insulin therapy for persons with type 1 diabetes; and 6) multi-component interventions for diabetic risk factor control and early detection of complications compared with standard glycemic control for persons with type 2 diabetes. (II) Very cost-effective — 1) intensive lifestyle interventions to prevent type 2 diabetes among persons with impaired glucose tolerance compared with standard lifestyle recommendations; 2) universal opportunistic screening for undiagnosed type 2 diabetes in African Americans between 45 and 54 years old; 3) intensive glycemic control as implemented in the UK Prospective Diabetes Study in persons with newly diagnosed type 2 diabetes compared with conventional glycemic control; 4) statin therapy for secondary prevention of cardiovascular disease compared with no statin therapy; 5) counseling and treatment for smoking cessation compared with no counseling and treatment; 6) annual screening for diabetic retinopathy and ensuing treatment in persons with type 1 diabetes compared with no screening; 7) annual screening for diabetic retinopathy and ensuing treatment in persons with type 2 diabetes compared with no screening; and 8 ) immediate vitrectomy to treat diabetic retinopathy compared with deferred vitrectomy.

CONCLUSIONS — Many interventions intended to prevent/control diabetes are cost saving or very cost-effective and supported by strong evidence. Policy makers should consider giving these interventions a higher priority.”

In health cost-effectiveness analyses, it’s quite common to find measures/interventions that are cost-effective but do not actually save ‘you’ money, because the effectiveness variable is some sort of (/weighted) effect/$ measure. There’s also always the problem with figuring out what’s the relevant alternative course of (in-?)action. But what I found very, very interesting here is that one of these interventions was actually cost-saving when compared to doing nothing:

“The six cost-saving interventions with strong evidence were [...] 2) ACEI or ARB therapy to prevent ESRD for type 2 diabetes compared with no ACEI or ARB therapy”

This is very interesting. Of course it’s also noteworthy that quite a few other treatment options would actually be cost saving if implemented on a larger scale than is currently the case. I should probably also comment on some of the stuff that’s not worth the money:

“The four interventions with strong evidence of not being cost-effective were 1) one-time universal opportunistic screening for undiagnosed type 2 diabetes among those aged 45 years and older compared with no screening; 2) universal
screening for type 2 diabetes compared with targeted screening; 3) intensive glycemic control in the U.S. setting for patients diagnosed with diabetes at older ages (55–94 years of age) compared with usual care; and 4) annual screening for retinopathy compared with screening every two years. All these studies were for type 2 diabetes.”

Some sort of universal opportunistic screening program is one of those things that might sound like a good idea, but probably isn’t. It’s just too damn expensive. Btw., when applying age-targeting approaches it’s not at all clear where to place the cut-off point:

“Current evidence is uncertain on how the CE of screening for undiagnosed type 2 diabetes would change with the age of
those screened. Two studies evaluated the CE of screening for undiagnosed type 2 diabetes; one study reported that costeffectiveness ratios (CERs) increased with initial screening age (16) while the other reported that they decreased with screening age (35).”

December 13, 2011 Posted by | diabetes, studies | Leave a comment

   

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