Neda Laiteerapong, MD, MS; Jennifer M. Cooper, MPH; M. Reza Skandari, PhD; Philip M. Clarke, PhD; Aaron N. Winn, PhD; Rochelle N. Naylor, MD; Elbert S. Huang, MD, MPH
Note: Dr. Laiteerapong and Ms. Cooper had access to the data in the study. Dr. Laiteerapong takes full responsibility for the integrity of the data and the accuracy of the data analysis. The authors completed the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist (Supplement).
Financial Support: Dr. Laiteerapong was supported by grant K23 DK092783 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Dr. Huang is supported by grant K24 DK105340 from the NIDDK. Drs. Laiteerapong and Huang are members of the NIDDK Chicago Center for Diabetes Translation Research at the University of Chicago (P30 DK092949). Dr. Winn was supported by the Royster Society of Fellows at the University of North Carolina at Chapel Hill.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0537.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Readers with questions about the simulation model used in this analysis may contact Dr. Laiteerapong (e-mail, firstname.lastname@example.org). The model is not available without written agreement with the authors.
Requests for Single Reprints: Neda Laiteerapong, MD, MS, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637; e-mail, email@example.com.
Current Author Addresses: Drs. Laiteerapong, Skandari, Naylor, and Huang: Department of Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637.
Ms. Cooper: Northwestern University, 633 North St. Clair Street, Suite 1800, Chicago, IL 60611.
Dr. Clarke: Center for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Victoria 3053, Australia.
Dr. Winn: Assistant Professor, Medical College of Wisconsin School of Pharmacy, 8701 Watertown Plank Road, Milwaukee, WI 53226.
Author Contributions: Conception and design: N. Laiteerapong, M.R. Skandari, R.N. Naylor.
Analysis and interpretation of the data: N. Laiteerapong, J.M. Cooper, P.M. Clarke, A.N. Winn.
Drafting of the article: N. Laiteerapong, M.R. Skandari, A.N. Winn.
Critical revision of the article for important intellectual content: N. Laiteerapong, M.R. Skandari, P.M. Clarke, A.N. Winn, R.N. Naylor, E.S. Huang.
Final approval of the article: N. Laiteerapong, J.M. Cooper, M.R. Skandari, P.M. Clarke, A.N. Winn, R.N. Naylor, E.S. Huang.
Statistical expertise: N. Laiteerapong, M.R. Skandari, A.N. Winn.
Obtaining of funding: N. Laiteerapong, E.S. Huang.
Administrative, technical, or logistic support: N. Laiteerapong, J.M. Cooper, A.N. Winn, E.S. Huang.
Collection and assembly of data: N. Laiteerapong, J.M. Cooper, A.N. Winn.
Intensive glycemic control in type 2 diabetes (glycated hemoglobin [HbA1c] level <7%) is an established, cost-effective standard of care. However, guidelines recommend individualizing goals on the basis of age, comorbidity, diabetes duration, and complications.
To estimate the cost-effectiveness of individualized control versus uniform intensive control (HbA1c level <7%) for the U.S. population with type 2 diabetes.
Patient-level Monte Carlo–based Markov model.
National Health and Nutrition Examination Survey 2011–2012.
The approximately 17.3 million persons in the United States with diabetes diagnosed at age 30 years or older.
Health care sector.
Individualized versus uniform intensive glycemic control.
Average lifetime costs, life-years, and quality-adjusted life-years (QALYs).
Individualized control saved $13 547 per patient compared with uniform intensive control ($105 307 vs. $118 854), primarily due to lower medication costs ($34 521 vs. $48 763). Individualized control decreased life expectancy (20.63 vs. 20.73 years) due to an increase in complications but produced more QALYs (16.68 vs. 16.58) due to fewer hypoglycemic events and fewer medications.
Individualized control was cost-saving and generated more QALYs compared with uniform intensive control, except in analyses where the disutility associated with receiving diabetes medications was decreased by at least 60%.
The model did not account for effects of early versus later intensive glycemic control.
Health policies and clinical programs that encourage an individualized approach to glycemic control for U.S. adults with type 2 diabetes reduce costs and increase quality of life compared with uniform intensive control. Additional research is needed to confirm the risks and benefits of this strategy.
National Institute of Diabetes and Digestive and Kidney Diseases.
Laiteerapong N, Cooper JM, Skandari MR, Clarke PM, Winn AN, Naylor RN, et al. Individualized Glycemic Control for U.S. Adults With Type 2 Diabetes: A Cost-Effectiveness Analysis. Ann Intern Med. ;168:170–178. doi: 10.7326/M17-0537
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Published: Ann Intern Med. 2018;168(3):170-178.
Published at www.annals.org on 12 December 2017
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, High Value Care.
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