The 30-year cost-effectiveness of alternative strategies to achieve excellent glycemic control in type 1 diabetes: An economic simulation informed by the results of the diabetes control and complications trial/epidemiology of diabetes interventions and complications (DCCT/EDIC).

摘要: Abstract Objective To simulate the cost-effectiveness of historical and modern treatment scenarios that achieve excellent vs. poor glycemic control in type 1 diabetes (T1DM). Research design methods We describe compare costs intensive conventional therapies for T1DM as performed during DCCT, basic therapy using insulin analogs, pens, pumps, continuous glucose monitoring (CGM) to or control. then assess differences outcomes over 30 years report incremental ratios. Results Over 30 years, DCCT cost $127,500 $181,600 more per participant than therapy, $87,700 $409,000 individual therapy. Excellent averted much $90,900 from complications added ~1.62 quality-adjusted life-years (QALYs) 30 years. When QALYs were discounted at 3% annually, use multiple daily injections (MDI) pumps are cost-saving cost-effective ( $250,000/QALY-gained) but would be if associated with less hypoglycemia, better control, fewer complications, improved health-related quality-of-life. Conclusions Use least expensive needed safely goals patients represents a good value money. Trial registration clinicaltrials.gov NCT00360815 NCT00360893 .