A cost analysis of intensified vs conventional multifactorial therapy in individuals with type 2 diabetes: a post hoc analysis of the Steno-2 study

Joachim Gæde, Jens Oellgaard, Rikke Ibsen, Peter Gæde, Emil Nørtoft, Hans Henrik Parving, Jakob Kjellberg, Oluf Pedersen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Aims/hypothesis: Long-term follow-up of the Steno-2 study demonstrated that intensified multifactorial intervention increased median lifespan by 7.9 years and delayed incident cardiovascular disease by a median of 8.1 years compared with conventional multifactorial intervention during 21.2 years of follow-up. In this post hoc analysis of data from the Steno-2 study, we aimed to study the difference in direct medical costs associated with conventional vs intensified treatment. Methods: In 1993, 160 Danish individuals with type 2 diabetes and microalbuminuria were randomised to conventional or intensified multifactorial target-driven intervention for 7.8 years. Information on direct healthcare costs was retrieved from health registries, and the costs in the two groups of participants were compared by bootstrap t test analysis. Results: Over 21.2 years of follow-up, there was no difference in total direct medical costs between the intensified treatment group, €12,126,900, and the conventional treatment group, €11,181,700 (p = 0.48). The mean cost per person-year during 1996–2014 was significantly lower in the intensified treatment group (€8725 in the intensive group and €10,091 in the conventional group, p = 0.045). The main driver of this difference was reduced costs associated with inpatient admissions related to cardiovascular disease (p = 0.0024). Conclusions/interpretation: Over a follow-up period of 21.2 years, we found no difference in total costs and reduced cost per person-year associated with intensified multifactorial treatment for 7.8 years compared with conventional multifactorial treatment. Considering the substantial gain in life-years and health benefits achieved with intensified treatment, we conclude that intensified multifaceted intervention in high-risk individuals with type 2 diabetes seems to be highly feasible when balancing healthcare costs and treatment benefits in a Danish healthcare setting.

SprogEngelsk
TidsskriftDiabetologia
Vol/bind62
Udgave nummer1
Sider147-155
ISSN0012-186X
DOI
StatusUdgivet - jan. 2019

Fingeraftryk

Type 2 Diabetes Mellitus
Insurance Benefits
Cost-Benefit Analysis
Registries
Inpatients
Delivery of Health Care

Emneord

    Citer dette

    Gæde, Joachim ; Oellgaard, Jens ; Ibsen, Rikke ; Gæde, Peter ; Nørtoft, Emil ; Parving, Hans Henrik ; Kjellberg, Jakob ; Pedersen, Oluf. / A cost analysis of intensified vs conventional multifactorial therapy in individuals with type 2 diabetes : a post hoc analysis of the Steno-2 study. I: Diabetologia. 2019 ; Bind 62, Nr. 1. s. 147-155.
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    title = "A cost analysis of intensified vs conventional multifactorial therapy in individuals with type 2 diabetes: a post hoc analysis of the Steno-2 study",
    abstract = "Aims/hypothesis: Long-term follow-up of the Steno-2 study demonstrated that intensified multifactorial intervention increased median lifespan by 7.9 years and delayed incident cardiovascular disease by a median of 8.1 years compared with conventional multifactorial intervention during 21.2 years of follow-up. In this post hoc analysis of data from the Steno-2 study, we aimed to study the difference in direct medical costs associated with conventional vs intensified treatment. Methods: In 1993, 160 Danish individuals with type 2 diabetes and microalbuminuria were randomised to conventional or intensified multifactorial target-driven intervention for 7.8 years. Information on direct healthcare costs was retrieved from health registries, and the costs in the two groups of participants were compared by bootstrap t test analysis. Results: Over 21.2 years of follow-up, there was no difference in total direct medical costs between the intensified treatment group, €12,126,900, and the conventional treatment group, €11,181,700 (p = 0.48). The mean cost per person-year during 1996–2014 was significantly lower in the intensified treatment group (€8725 in the intensive group and €10,091 in the conventional group, p = 0.045). The main driver of this difference was reduced costs associated with inpatient admissions related to cardiovascular disease (p = 0.0024). Conclusions/interpretation: Over a follow-up period of 21.2 years, we found no difference in total costs and reduced cost per person-year associated with intensified multifactorial treatment for 7.8 years compared with conventional multifactorial treatment. Considering the substantial gain in life-years and health benefits achieved with intensified treatment, we conclude that intensified multifaceted intervention in high-risk individuals with type 2 diabetes seems to be highly feasible when balancing healthcare costs and treatment benefits in a Danish healthcare setting.",
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    author = "Joachim G{\ae}de and Jens Oellgaard and Rikke Ibsen and Peter G{\ae}de and Emil N{\o}rtoft and Parving, {Hans Henrik} and Jakob Kjellberg and Oluf Pedersen",
    year = "2019",
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    doi = "10.1007/s00125-018-4739-3",
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    A cost analysis of intensified vs conventional multifactorial therapy in individuals with type 2 diabetes : a post hoc analysis of the Steno-2 study. / Gæde, Joachim; Oellgaard, Jens; Ibsen, Rikke; Gæde, Peter; Nørtoft, Emil; Parving, Hans Henrik; Kjellberg, Jakob; Pedersen, Oluf.

    I: Diabetologia, Bind 62, Nr. 1, 01.2019, s. 147-155.

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

    TY - JOUR

    T1 - A cost analysis of intensified vs conventional multifactorial therapy in individuals with type 2 diabetes

    T2 - Diabetologia

    AU - Gæde, Joachim

    AU - Oellgaard, Jens

    AU - Ibsen, Rikke

    AU - Gæde, Peter

    AU - Nørtoft, Emil

    AU - Parving, Hans Henrik

    AU - Kjellberg, Jakob

    AU - Pedersen, Oluf

    PY - 2019/1

    Y1 - 2019/1

    N2 - Aims/hypothesis: Long-term follow-up of the Steno-2 study demonstrated that intensified multifactorial intervention increased median lifespan by 7.9 years and delayed incident cardiovascular disease by a median of 8.1 years compared with conventional multifactorial intervention during 21.2 years of follow-up. In this post hoc analysis of data from the Steno-2 study, we aimed to study the difference in direct medical costs associated with conventional vs intensified treatment. Methods: In 1993, 160 Danish individuals with type 2 diabetes and microalbuminuria were randomised to conventional or intensified multifactorial target-driven intervention for 7.8 years. Information on direct healthcare costs was retrieved from health registries, and the costs in the two groups of participants were compared by bootstrap t test analysis. Results: Over 21.2 years of follow-up, there was no difference in total direct medical costs between the intensified treatment group, €12,126,900, and the conventional treatment group, €11,181,700 (p = 0.48). The mean cost per person-year during 1996–2014 was significantly lower in the intensified treatment group (€8725 in the intensive group and €10,091 in the conventional group, p = 0.045). The main driver of this difference was reduced costs associated with inpatient admissions related to cardiovascular disease (p = 0.0024). Conclusions/interpretation: Over a follow-up period of 21.2 years, we found no difference in total costs and reduced cost per person-year associated with intensified multifactorial treatment for 7.8 years compared with conventional multifactorial treatment. Considering the substantial gain in life-years and health benefits achieved with intensified treatment, we conclude that intensified multifaceted intervention in high-risk individuals with type 2 diabetes seems to be highly feasible when balancing healthcare costs and treatment benefits in a Danish healthcare setting.

    AB - Aims/hypothesis: Long-term follow-up of the Steno-2 study demonstrated that intensified multifactorial intervention increased median lifespan by 7.9 years and delayed incident cardiovascular disease by a median of 8.1 years compared with conventional multifactorial intervention during 21.2 years of follow-up. In this post hoc analysis of data from the Steno-2 study, we aimed to study the difference in direct medical costs associated with conventional vs intensified treatment. Methods: In 1993, 160 Danish individuals with type 2 diabetes and microalbuminuria were randomised to conventional or intensified multifactorial target-driven intervention for 7.8 years. Information on direct healthcare costs was retrieved from health registries, and the costs in the two groups of participants were compared by bootstrap t test analysis. Results: Over 21.2 years of follow-up, there was no difference in total direct medical costs between the intensified treatment group, €12,126,900, and the conventional treatment group, €11,181,700 (p = 0.48). The mean cost per person-year during 1996–2014 was significantly lower in the intensified treatment group (€8725 in the intensive group and €10,091 in the conventional group, p = 0.045). The main driver of this difference was reduced costs associated with inpatient admissions related to cardiovascular disease (p = 0.0024). Conclusions/interpretation: Over a follow-up period of 21.2 years, we found no difference in total costs and reduced cost per person-year associated with intensified multifactorial treatment for 7.8 years compared with conventional multifactorial treatment. Considering the substantial gain in life-years and health benefits achieved with intensified treatment, we conclude that intensified multifaceted intervention in high-risk individuals with type 2 diabetes seems to be highly feasible when balancing healthcare costs and treatment benefits in a Danish healthcare setting.

    KW - Health economy

    KW - Multifactorial intervention

    KW - Organ complications

    KW - Type 2 diabetes

    U2 - 10.1007/s00125-018-4739-3

    DO - 10.1007/s00125-018-4739-3

    M3 - Journal article

    VL - 62

    SP - 147

    EP - 155

    JO - Diabetologia

    JF - Diabetologia

    SN - 0012-186X

    IS - 1

    ER -