Table 5Studies Modeling Treatment of Persons with Newly-Diagnosed Type 2 Diabetes (KQ2)

Author, Year
Model (in date order)
Type of screening;
Type of model
Time Horizon
Included costs
Discount rate
Data sources
Global Diabetes Model
Brown et al, 2000126, 133
Monte Carlo microsimulation, using continuous prediction equations

5000 newly diagnosed DM2 white males; no CVD or other macro- or microvascular complications; based on Kaiser health maintenance organization

Direct medical costs

Intensive lipid management (LDL from 150 to 100 mg/dl and HDL from 40 to 50 mg/dl)

Kaiser databases, world scientific literature, observational data such as Framingham Heart Study
A1c 9.5%, SBP 130:
% survival: 82.7%
Total costs per person ($US): $85,920
Lower costs for lower A1c, higher costs for higher SBP
Survival improves with intensive lipid therapy
(Center for Disease Control and Prevention/Research Triangle Institiute)
Diabetes Group 2002123
Health care system (for costs)Markov model; emphasis on macrovascular complications
Subjects proceed through 5 different disease paths; nethropathy, neuropathy, retinopathy, CVD, stroke

Death or age 95y
Newly diagnosed DM2; 55% female, 8% 25–34y, 8% 35–44y, 26% 45–54y, 18% 55–64y, 23% 65–74y, 13% 75–84, 4% 84–94y

Health care system only; no indirect or direct patient costs

Costs and QALYs discounted at 3% annually
All subjects received conventional treatment to control BG (UKPDS control arm)
Intensive glycemic control: to reduce FPG to <108 mg/dl using chlorpropamide, glipizide, insulin
Intensified HT control: ACE-I or Beta-blocker for baseline BP≥160/95
Reduction in TC: pravastatin for baseline level ≥200 mg/dl

UKPDS and other sources
Intensive glycemic control applied to all persons newly diagnosed with DM2 in the US: increase in QALY of 0.1915 (discounted), CE ratio: $41,384 per QALY; CE ratio increases markedly with age; cumulate incidence of nethropathy, neuropathy, retinopathy decreased by 11 to 27%
Intensified HT control: increased QALYs by 0.392 relative to moderate HT control; CE ratio - $1,959/QALY (ie cost savings); age had little effect;
Reduction in TC: increase discounted QALYs 0.3475, CE ratio $51,889 per QALY, lowest ratio for 45–85y
Intensified HT control reduced costs and improved health outcomes relative to moderate HT control; intensive glycemic control and reduction in serum TC increase costs and improve health outcomes
Intensive glycemic control is most cost-effective for younger persons
CORE Model
(Center for Outcomes Research)
Palmer et al, 2004124, 128
Third party payerMarkov using Monte Carlo simulation; 15 submodels each of which simulates different complications associated with DM

Newly diagnosed patients: baseline age 52y, A1c 9.1%, SBP 137 mm Hg, TC 212 mg/dl, HDL 39 mg/dl
Switzerland; modeled using US payer costs
Direct medical costs; day-to-day DM management costs excluded; expressed in 2003 values in the US setting

3% annual rate for costs; outcomes not discounted
Hypothetical interventions that led to individual 10% improvements in A1c, SBP, TC, HDL
UKPDS, Framingham, other published sources
QALE: increased 1.72y with improvements in all of A1c, SBP, TC, HDL
Lifetime costs of DM-related complications: decreased $14,533 with improvements in all of A1c, SBP, TC, HDL; improved A1c alone: decreased $10,800, SBP alone: decreased $7,048
10% improvements in A1c, SBP, TC, HDL, individually and in combination are likely to improve length and quality of life; most marked improvement with all 4; individually A1c had greatest gains in QALE
(United Kingdom Prospective Diabetes Study) Outcomes Model
Clarke et al, 2005125
Health care purchaserProbabilistic discrete-time illness-death model

Lifetime (Clarke 2005125)
Within-trial data: mean duration 10.3y (Clarke 2003130)
Newly diagnosed DM2 aged 25–65y; mean age 52.4y, 58% male; 81% Caucasian; n=3867

Direct medical costs

3.5% annually
Intensive BG control with insulin or sulphonylurea vs conventional glucose control (mainly diet); 342 patients >120% ideal body weight assigned to metformin and 411 overweight patients on conventional treatment
Embedded study randomized 1148 patients with HT to BP<180/<105 vs n=758 with BP goal <150/85 mm Hg

UKPDS for both outcomes and costs
QALY per patient modeled over lifetime:
Intensive BG control: 0.15(-0.20, 0.49)
Metformin therapy: 0.55(-0.10, 1.20)
Tight BP control: 0.29(-0.14, 0.59)

Probability of being cost-effective at a ceiling ratio of 20,000 Pounds per QALY:
Intensive BG control: 74%
Metformin therapy: 98%
Tight BP control: 86%

Life years gained per patient with metformin treatment versus conventional, within-trial data: 0.6 (95% CI, 0.0, 1.2)
Intensive BG control and BP control for persons with HT adds QALYs over lifetime; relatively cost-effective compared to many other accepted uses of health care resources

Abbreviations: ACE, angiotension-converting enzyme; BG, blood glucose; BP, blood pressure; CDC, Centers for Disease Control; CE, cost effectiveness; CVD, coronary vascular disease; DM2, type 2 diabetes; FPG, fasting plasma glucose; HDL, high-density lipoprotein; HT, hypertension; LDL, low-density lipoprotein; NA, Not applicable; QALE, quality-adjusted life expectancy; QALY, quality-adjusted life years; RTI, Research Triangle Institute; SBP, systolic blood pressure; TC, total cholesterol; UKPDS, United Kingdom Prospective Diabetes Study; y, year.

From: Summary Tables

Cover of Screening for Type 2 Diabetes Mellitus: Update of 2003 Systematic Evidence Review for the U.S. Preventive Services Task Force
Screening for Type 2 Diabetes Mellitus: Update of 2003 Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet].
Evidence Syntheses, No. 61.
Norris SL, Kansagara D, Bougatsos C, et al.

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