Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: Economic analysis alongside randomised controlled trial (UKPDS 41)
Gray A., Turner R., Raikou M., McGuire A., Fenn P., Stevens R., Cull C., Stratton I., Adler A., Holman R.
Objective. To estimate the cost effectiveness of conventional versus intensive blood glucose control in patients with type 2 diabetes. Design. Incremental cost effectiveness analysis alongside randomised controlled trial. Setting. 23 UK hospital clinic based study centres. Participants. 3867 patients with newly diagnosed type 2 diabetes (mean age 53 years). Interventions. Conventional (primarily diet) glucose control policy versus intensive control policy with a sulphonylurea or insulin. Main outcome measures. Incremental cost per event-free year gained within the trial period. Results. Intensive glucose control increased trial treatment costs by u695 (95% confidence interval u555 to u836) per patient but reduced the cost of complications by u957 (u233 to u1681) compared with conventional management. If standard practice visit patterns were assumed rather than trial conditions, the incremental cost of intensive management was u478 (-u275 to u1232) per patient. The within trial event-free time gained in the intensive group was 0.60 (0.12 to 1.10) years and the lifetime gain 1.14 (0.69 to 1.61) years. The incremental cost per event-free year gained was u1166 (costs and effects discounted at 6% a year) and u563 (costs discounted at 6% a year and effects not discounted). Conclusions. Intensive blood glucose control in patients with type 2 diabetes significantly increased treatment costs but substantailly reduced the cost of complications and increased the time free of complications.