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*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

56 Downloads (Pure)

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.

Original languageEnglish
JournalDiabetologia
Volume62
Issue number1
Pages (from-to)147-155
ISSN0012-186X
DOIs
Publication statusPublished - Jan 2019

Fingerprint

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

Keywords

  • Health economy
  • Multifactorial intervention
  • Organ complications
  • Type 2 diabetes

Cite this

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. In: Diabetologia. 2019 ; Vol. 62, No. 1. pp. 147-155.
@article{c546dd21a03745eda67f4e82fa108636,
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.",
keywords = "Health economy, Multifactorial intervention, Organ complications, Type 2 diabetes",
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",
month = "1",
doi = "10.1007/s00125-018-4739-3",
language = "English",
volume = "62",
pages = "147--155",
journal = "Diabetologia",
issn = "0012-186X",
publisher = "Heinemann",
number = "1",

}

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.

In: Diabetologia, Vol. 62, No. 1, 01.2019, p. 147-155.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

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

T2 - a post hoc analysis of the Steno-2 study

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 -