TY - JOUR
T1 - A cost analysis of intensified vs conventional multifactorial therapy in individuals with type 2 diabetes
T2 - a post hoc analysis of the Steno-2 study
AU - Gæde, Joachim
AU - Oellgaard, Jens
AU - Ibsen, Rikke
AU - Gæde, Peter
AU - Nørtoft, Emil
AU - Parving, Hans-Henrik
AU - Kjellberg, Jakob
AU - Pedersen, Oluf
PY - 2019/1
Y1 - 2019/1
N2 - AIMS/HYPOTHESIS: Long-term follow-up of the Steno-2 study demonstrated that intensified multifactorial intervention increased median lifespan by 7.9 years and delayed incident cardiovascular disease by a median of 8.1 years compared with conventional multifactorial intervention during 21.2 years of follow-up. In this post hoc analysis of data from the Steno-2 study, we aimed to study the difference in direct medical costs associated with conventional vs intensified treatment.METHODS: In 1993, 160 Danish individuals with type 2 diabetes and microalbuminuria were randomised to conventional or intensified multifactorial target-driven intervention for 7.8 years. Information on direct healthcare costs was retrieved from health registries, and the costs in the two groups of participants were compared by bootstrap t test analysis.RESULTS: Over 21.2 years of follow-up, there was no difference in total direct medical costs between the intensified treatment group, �12,126,900, and the conventional treatment group, �11,181,700 (p?=?0.48). The mean cost per person-year during 1996-2014 was significantly lower in the intensified treatment group (�8725 in the intensive group and �10,091 in the conventional group, p?=?0.045). The main driver of this difference was reduced costs associated with inpatient admissions related to cardiovascular disease (p?=?0.0024).CONCLUSIONS/INTERPRETATION: Over a follow-up period of 21.2 years, we found no difference in total costs and reduced cost per person-year associated with intensified multifactorial treatment for 7.8 years compared with conventional multifactorial treatment. Considering the substantial gain in life-years and health benefits achieved with intensified treatment, we conclude that intensified multifaceted intervention in high-risk individuals with type 2 diabetes seems to be highly feasible when balancing healthcare costs and treatment benefits in a Danish healthcare setting.
AB - AIMS/HYPOTHESIS: Long-term follow-up of the Steno-2 study demonstrated that intensified multifactorial intervention increased median lifespan by 7.9 years and delayed incident cardiovascular disease by a median of 8.1 years compared with conventional multifactorial intervention during 21.2 years of follow-up. In this post hoc analysis of data from the Steno-2 study, we aimed to study the difference in direct medical costs associated with conventional vs intensified treatment.METHODS: In 1993, 160 Danish individuals with type 2 diabetes and microalbuminuria were randomised to conventional or intensified multifactorial target-driven intervention for 7.8 years. Information on direct healthcare costs was retrieved from health registries, and the costs in the two groups of participants were compared by bootstrap t test analysis.RESULTS: Over 21.2 years of follow-up, there was no difference in total direct medical costs between the intensified treatment group, �12,126,900, and the conventional treatment group, �11,181,700 (p?=?0.48). The mean cost per person-year during 1996-2014 was significantly lower in the intensified treatment group (�8725 in the intensive group and �10,091 in the conventional group, p?=?0.045). The main driver of this difference was reduced costs associated with inpatient admissions related to cardiovascular disease (p?=?0.0024).CONCLUSIONS/INTERPRETATION: Over a follow-up period of 21.2 years, we found no difference in total costs and reduced cost per person-year associated with intensified multifactorial treatment for 7.8 years compared with conventional multifactorial treatment. Considering the substantial gain in life-years and health benefits achieved with intensified treatment, we conclude that intensified multifaceted intervention in high-risk individuals with type 2 diabetes seems to be highly feasible when balancing healthcare costs and treatment benefits in a Danish healthcare setting.
KW - Albuminuria/drug therapy
KW - Diabetes Mellitus, Type 2/drug therapy
KW - Health Care Costs/statistics & numerical data
KW - Hospitalization/economics
KW - Humans
U2 - 10.1007/s00125-018-4739-3
DO - 10.1007/s00125-018-4739-3
M3 - Article
C2 - 30293113
SN - 0012-186X
VL - 62
SP - 147
EP - 155
JO - Diabetologia
JF - Diabetologia
IS - 1
ER -