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Early HbA1c intervention reduces complications, yields financial benefits in diabetes
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Small, achievable and sustained improvements in HbA1c across the diabetes population in the United Kingdom can reduce the number of complications and the economic costs of dealing with them, according to recent study results.
The findings, according to researchers, are not predicated on any specific therapy, but rather more timely and appropriate interventions to improve care.
“Over 25 years, this amounts to the avoidance of 1 million microvascular complications and the cost avoidance of £5.5 billion. Glycemic control is clearly seen as a major influence on the development of microvascular complications,” Michael Baxter, PhD, FRCP, medical therapy advisor and consultant diabetologist at Sanofi, told Endocrine Today.
Michael Baxter
Baxter and colleagues with the York Health Economics Consortium Ltd. at University of York and IMS Health in London analyzed IMS Disease Analyzer data from adults with type 1 and type 2 diabetes, using the IMS Core Diabetes Model to estimate the impact of improved glycemic control (indicated by reduction in HbA1c level) at 5-year intervals up to 25 years. The cohort was stratified by HbA1c and disease type. Researchers modeled the cumulative incidence of microvascular and macrovascular complications across 5-year periods to a 25-year time horizon. Complication costs were applied to the data to estimate potential accrued cost avoidance.
Researchers found that virtually all cost reductions related to avoided microvascular complications after 25 years of improved glycemic control for people with type 1 and type 2 diabetes.
Assuming that better management could result in a 0.4% lower HbA1c level in patients with type 1 diabetes, per-person cost reduction over 25 years ranged from £2,057 for patients with baseline HbA1c 7.5% to £4,136 for patients with baseline HbA1c 9%, according to researchers.
“The total cost reductions in the current U.K. adults type 1 diabetes population could be £39 million over 5 years, rising to £995 million after 25 years of improved control,” the researchers wrote. A reduction in renal disease accounted for 75% of cost avoidance in type 1 diabetes, according to researchers.
Cost reductions over 25 years from avoided complications for patients with type 2 diabetes ranged from £1,280 per person with a baseline HbA1c of 7.5% to £2,223 for patients with a baseline HbA1c between 8% and 9%. Cost reductions in the current U.K. adult type 2 diabetes population could be £299 million over 5 years, rising to £4.5 billion over 25 years, the researchers wrote.
A reduction in diabetic foot disease, including foot ulcers, amputations and neuropathy, accounted for 57% of cost avoidance in type 2 diabetes, according to researchers.
Although patients with higher HbA1c have the highest risk and therefore the largest benefit, in population terms, patients with HbA1c below 7.5% actually contribute significantly to the disease burden, Baxter said.
“This means that a strategy based on an incremental improvement in all patients with diabetes, including those thought of as at target, would yield demonstrable financial and clinical benefits,” Baxter said. “These data provide the basis of an informed discussion on the benefits of improved HbA1c and a view of an alternate intervention strategy.”
The researchers noted that the analysis does not include costs associated with strategies implemented to improve glycemic control and does not take into account the increase in the population with diabetes. Costs associated with treating complications are based on unit costs inflated to 2014, and quality-adjusted life years are not considered. –by Regina Schaffer
For more information: Michael Baxter, PhD, FRCP, can be reached at Sanofi-Guildford, Onslow Street, Guildford GU1 4YS, United Kingdom; email: mike.baxter@sanofi.com.
Disclosure: The Impact Diabetes program was developed in partnership with Diabetes UK, JDRF and Sanofi Diabetes, and is funded by Sanofi. Baxter reports being a medical advisor contracted by Sanofi at the time this study was written; he is now a full-time employee of Sanofi. Please see the full study for the other authors’ relevant financial disclosures.
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