Improved health for patients with diabetes outweighed health care cost increases

Since 1997, improvements in health status for patients with diabetes have economically exceeded or equaled the increases in health care spending. However, researchers who reported this finding did not exclude the possibility that society “is getting less for its money.”

Researchers at the Mayo Clinic in Rochester, Minn., enrolled 613 patients with type 2 diabetes to assess the net value of health care. They measured the changes in inflation-adjusted annual health care spending and health status from 1997 to 2005 and simulated outcomes for all diabetes complications based on the U.K. Perspective Diabetes Study Outcomes Model. The researchers estimated net value as the present discounted monetary value of improved survival and avoided treatment spending, minus the increase in annual spending per patient.

Control of risk factors for coronary heart disease, including HbA1c level, mean systolic blood pressure and mean total cholesterol-to-HDL ratio improved during the study period. With these improvements, modifiable 10-year risk estimates for CHD decreased from 14.12% to 10.55%.

The researchers assumed that one life-year is worth $200,000 and accounted for changes in modifiable cardiovascular risk. Between 1997 and 1999 and between 2003 and 2005, reduction in modifiable risk for fatal CHD and fatal stroke resulted in a value of $17,392 per patient, plus $3,432 saved by preventing CHD — a total of $20,824. Based on this, the researchers estimated the net value for changes in health care for patients with type 2 diabetes was $10,911 per patient (95% CI, –$8,480 to $33,402).

In a second approach, the researchers estimated the value of improvements in life expectancy for the range of diabetes endpoints, rather than only CV risks. The value of improved life expectancy and avoided CHD treatment spending exceeded the health care spending increase by $6,931 for the average patient (95% CI, –$186,901 to $211,980).

This positive dollar value suggests an improvement in the value of health care in the face of increased spending. However, the researchers wrote that, “despite these findings, the rapid pace of spending increases seems unsustainable, so it is still necessary to enhance value for money spent on care for patients with chronic conditions, such as diabetes. Including improvements in ‘modifiable risk’ in payment incentives for provider organizations might help further that goal.”

Eggleston KN. Ann Intern Med. 2009;151:386-393.