Utility Decrements Associated With Diabetes and Related Complications: Estimates From a Population-Based Study in Germany

Objectives: Health utility decrement estimates for diabetes and complications are needed for parametrization of simulation models that aim to assess the cost-utility of diabetes prevention and care strategies. This study estimates health utility decrements associated with diabetes and cardiovascular and microvascular complications from a population-based German study. Methods: Data were obtained from the population based cross-sectional KORA (Cooperative Health Research in the Augsburg Region) health questionnaire 2016 and comprised n = 1072 individuals with type 2 diabetes and n = 7879 individuals without diabetes. Health utility was assessed through the EQ-5D-5L. We used linear regression models with interaction terms between type 2 diabetes and different cardiovascular and microvascular complications while adjusting for demographic and socio-economic factors and other comorbidities. Results: Type 2 diabetes (beta = -0.028, standard error [SE] = 0.014), stroke (beta = -0.070, SE = 0.010), cardiac arrhythmia (beta = -0.031, SE = 0.006), heart failure (beta = -0.073, SE = 0.009), coronary heart disease (beta = -0.028, SE = 0.010), myocardial infarction (beta = -0.020, SE = 0.011, estimates of main effect), and neuropathy (beta= -0.067, SE = 0.020), diabetic foot (beta = -0.042, SE = 0.030), nephropathy (beta = -0.032, SE = 0.025), and blindness (beta = -0.094, SE = 0.056, estimates of interaction terms) were negatively associated with health utility. The interaction term for diabetes x stroke (beta = -0.052, SE = 0.021) showed that the utility decrement for stroke is significantly larger in people with type 2 diabetes than in people without diabetes. Conclusions: Diabetes, cardiovascular, and microvascular conditions are associated with significant health utility decrements. Utility decrements for some conditions differ between people with and without type 2 diabetes. These results are of high relevance for the parametrization of decision analytic simulation models and applied health economic evaluations in the field of prevention and management of type 2 diabetes in Germany.

Automated summary

This study estimated health utility decrements associated with diabetes and its complications in a German population study. The results showed significant negative associations between diabetes, cardiovascular, and microvascular conditions with health utility decrements. The study also found differences in utility decrements for certain conditions between individuals with and without type 2 diabetes.