Similarly effective international guidelines for managing cardiovascular risk factors in type 2 diabetes vary in costs
Research Activities, December 2011, No. 376
A comparison of international guidelines for management of the cardiovascular risk factors (high blood-lipid levels and high blood pressure) in patients with type 2 diabetes finds them equally effective. However, they differ substantially in expected medication costs, according to a new study. The researchers found that all of the guidelines were comparable in efficacy, with a range of cardiovascular or stroke events per 1,000 patients treated ranging from 132.3 to 153.9 for males and 133.0 to 154.3 for females.
The number of events avoided with immediate treatment were 81.0 and 70.7 per 1,000 for males and females, respectively. The medication costs per event avoided were highest using the Australian guideline ($157,186 for males and $163,775 for females), with various U.S. guidelines ranging from $117,269-$141,185 for males and from $115,999-$147,011 for females. The researchers estimated that the additional cost to treat 1 million males (newly diagnosed with type 2 diabetes) with the Australian guideline rather than the current U.S. guidelines would be $3.3 trillion and lead to 2,518 fewer people experiencing a cardiovascular event.
The researchers compared four sets of U.S. clinical practice guidelines—and one set each from Canada, Europe (multinational), Great Britain, and Australia—for treatment efficacy and cost, with the initiation of hyperlipidemia and hypertension treatment at the diagnosis of type 2 diabetes. Their models used some 15,000 measurements, taken over 10 years, of cholesterol levels, blood pressure, and glycosylated hemoglobin (a measure of blood-sugar level) from 663 patients with type 2 diabetes. They used the data to calculate probabilities of cardiovascular and stroke events and rates of death. The study was funded in part by the Agency for Healthcare Research and Quality (HS17628).
More details are in "Comparative effectiveness of guidelines for the management of hyperlipidemia and hypertension for type 2 diabetes patients," by Nilay D. Shah, Ph.D., Jennifer Mason, M.Sc., Murat Kurt, Ph.D., and others in PLoS ONE 6(1), 2011.