Cost-effectiveness of intensified versus conventional multifactorial intervention in type 2 diabetes -: Results and projections from the Steno-2 study

OBJECTIVE - To assess the cost - effectiveness of intensive versus conventional therapy for 8 years as applied in the Steno-2 study in patients with type 2 diabetes and ruicroalbuminuria. RESEARCH DESIGN AND METHODS - A Markov model was developed to incorporate event and risk data front Steno-2 and account Danish-specific Costs to Project life expectancy, quality-adjusted life expectancy (QALE), and lifetime direct medical costs expressed in year 2005 Euros. Clinical and cost outcomes were projected over patient lifetimes and discounted at 3% annually. Sensitivity analyses were performed. RESULTS - intensive treatment was associated with increased life expectancy, QALE, and lifetime costs compared with conventional treatment. Mean +/- SD undiscounted life expectancy was 18.1 +/- 7.9 years with intensive treatment and 16.2 +/- 7.3 years with conventional treatment (difference 1.9 years). Discounted life expectancy was 13.4 +/- 4.8 years with intensive treatment and 12.4 +/- 4.5 years with conventional treatment. Lifetime costs (discounted) for intensive and conventional treatment were (sic)45,521 +/- 19,697 and (sic)41,319 +/- 27,500, respectively (difference (sic)4,202). Increased costs with intensive treatment were clue to increased pharmacy and consultation costs. Discounted QALE was 1.66 quality-adjusted life-years (QALYs) higher for intensive (10.2 +/- 3.6 QALYs) Versus conventional (8.6 +/- 2.7 QALYs) treatment, resulting in an incremental cost-effectiveness ratio of (sic)2,538 per QALY gained. This is considered a conservative estimate because accounting prescription of generic drugs and capturing indirect Costs would further favor intensified therapy. CONCLUSIONS - From a health care payer perspective in Denmark, intensive therapy was more cost-effective than conventional treatment. Assuming that patients in both arms were treated in a primary care setting, intensive therapy became dominant (cost- and lifesaving).