ORLANDO, Fla., June 24, 2018 /PRNewswire-USNewswire/ -- When
patients with type 2 diabetes (T2D) receive intensified,
multifactorial treatment combining lifestyle modification and
pharmacological therapy for modifiable risk factors, there is no
significant increase in medical costs, compared to patients who
receive conventional, multifactorial treatment, according to the
study, "A Cost Analysis of Intensified vs. Conventional
Multifactorial Therapy of Patients with Type 2 Diabetes—The Steno 2
Study," presented today at the American Diabetes
Association's® (ADA's) 78th Scientific
Sessions® at the Orange
County Convention Center.
People with T2D have an increased risk of damage to the eyes,
kidneys, nerves, legs, heart and brain, and many of these
complications can ultimately affect mortality. The 1993 Steno 2
study investigated whether a targeted, intensified, multifactorial
regimen would have an impact on the mortality rate of patients with
T2D from any cause, including cardiovascular causes. The trial
enrolled 160 Danish people with T2D with consistent
microalbuminuria and an average age of 55 years. Very small amounts
of albumin in the urine indicates generalized blood vessel damage
and is a strong predictor of premature, multiple organ damage.
The patients were randomly assigned to two groups: 80 patients
received conventional multifactorial treatment, based upon
recommendations of the Danish Medical Association at the time; and
80 patients received intensified multifactorial intervention. In
the intensified treatment group, all modifiable risk factors were
treated ambitiously, and the group's target levels for blood
glucose, HbA1c, blood pressure, total cholesterol, LDL cholesterol
and triglycerides were lower than those for the conventional
treatment group. Treatment focused on polypharmacological
approaches to cardiovascular issues, as well as improved health
behaviors via nutrition, exercise and smoking cessation.
After 7.8 years of treatment, the people in the intensified
treatment group had an approximate 50 percent reduction in
diabetes-related damage to the heart, brain and legs, compared to
the patients receiving conventional care. All patients were
subsequently followed observationally for an average of 5.5 years
in a post-trial setting in which all study participants received
intensified, multifactorial treatment. At 13.3 years follow-up, the
group originally allocated to intensified treatment had a 50
percent reduction in mortality, and at 21.2 years follow-up, a
median of 7.9 years of gain of life was demonstrated. The increase
in lifespan was matched by the amount of time the patients went
without cardiovascular disease incidents.
The current analysis compared the long-term economic
implications of the intensified multifactorial intervention to
conventional treatment over the 21.2-year timeframe. Information on
direct health costs was gathered from Danish health registers.
Researchers found no difference in total direct medical costs
between the intensified treatment group and the conventional
treatment group over the 21.2 years of follow-up. The total costs
in the intensified treatment group was approximately $13 million, and total costs in the conventional
treatment group was $12.3 million
(p=0.19). The data also indicated a statistically significant lower
health cost per-patient, per-year in the intensified treatment
group ($9,648 per patient), compared
to the conventional treatment group ($10,681 per patient; p=0.13) during the entire
follow-up period. Intensified treatment was, on average, more
expensive in terms of medication costs, but less costly in terms of
primary care visits and inpatient admission services related to
cardiovascular issues.
"The Steno-2 trial was instrumental in establishing treatment
standards for people with T2D, so it was important that we weighed
the costs of the intensified multifactorial treatment recommended
in the study," said junior lead study author Joachim Gaede, a graduate student in the
medicine program at the University of
Copenhagen in Denmark. "We
discovered that while intensified, multifactorial treatment may
lead to an initial increase in health care costs, this investment
is recouped over time by the impressive health benefits and
increased longevity the patients experienced. Additionally, the
total direct costs of intensified, multifactorial intervention,
which leads to disease-free-life length improvement of about eight
years, was neutral compared to conventional treatment. So, in terms
of cost, investing in early-intensified intervention of all known
modifiable risk factors in high-risk individuals with T2D will pay
for itself over time due to a reduced cost of complications
incurred by patients."
To speak with Mr. Gaede, please contact the ADA Press Office
on-site at the Orange County
Convention Center on June 22 - 26, by
phone at 407-685-4010 or by email at press@diabetes.org.
The American Diabetes Association's 78th Scientific Sessions, to
be held June 22-26, 2018, at the
Orange County Convention Center in
Orlando, is the world's largest
scientific meeting focused on diabetes research, prevention and
care. During the five-day meeting, more than 16,000 health care
professionals from around the world will have exclusive access to
more than 3,000 original diabetes research presentations,
participate in provocative and engaging exchanges with leading
diabetes experts, and can earn Continuing Medical Education (CME)
or Continuing Education (CE) credits for educational sessions. The
program is grouped into eight theme areas: Acute and Chronic
Complications; Behavioral Medicine, Clinical Nutrition, Education
and Exercise; Clinical Diabetes/Therapeutics;
Epidemiology/Genetics; Immunology/Transplantation; Insulin
Action/Molecular Metabolism; Integrated Physiology/Obesity; and
Islet Biology/Insulin Secretion. Felicia
Hill-Briggs, PhD, ABPP, President of Health Care and
Education, will deliver her address, "The American Diabetes
Association in the Era of Health Care Transformation," on
Saturday, June 23, and Jane E.B. Reusch, MD, President of Medicine and
Science, will present her address, "24/7/365 – Lifetime with
Diabetes," on Sunday, June 24. In
total, the 2018 Scientific Sessions includes 375 oral
presentations; 2,117 poster presentations, including 47 moderated
poster discussions; and 297 published-only abstracts. Join the
Scientific Sessions conversation on social media using
#2018ADA.
About the American Diabetes Association
Nearly half of
American adults have diabetes or prediabetes; more than 30 million
adults and children have diabetes; and every 21 seconds, another
individual is diagnosed with diabetes in the U.S. Founded in 1940,
the American Diabetes Association (ADA) is the nation's leading
voluntary health organization whose mission is to prevent and cure
diabetes, and to improve the lives of all people affected by
diabetes. The ADA drives discovery by funding research to treat,
manage and prevent all types of diabetes, as well as to search for
cures; raises voice to the urgency of the diabetes epidemic; and
works to safeguard policies and programs that protect people with
diabetes. In addition, the ADA supports people living with
diabetes, those at risk of developing diabetes, and the health care
professionals who serve them through information and programs that
can improve health outcomes and quality of life. For more
information, please call the ADA at 1-800-DIABETES (1-800-342-2383)
or visit diabetes.org. Information from both of these sources is
available in English and Spanish. Find us on Facebook (American
Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram
(@AmDiabetesAssn).
162-OR
|
A Cost Analysis of
Intensified vs. Conventional Multifactorial Therapy of Patients
with Type 2 Diabetes—The Steno 2 Study
|
78th Scientific Sessions
News
Briefing: Diabetes & Cardiovascular Disease, Sunday, June 24, 9:00 a.m.
ET
Presentation: Oral Presentations
Location: W203
Session Time: Sunday, June 24, 2018,
8:00 am - 10:00 am
JOACHIM GAEDE, JENS OELLGAARD,
RIKKE IBSEN, PETER GÆDE, EMIL
NOERTOFT, JAKOB KJELLBERG,
OLUF PEDERSEN, SR., Copenhagen, Denmark, Slagelse, Denmark, Aarhus,
Denmark, Søborg, Denmark
Introduction: Follow-up at 21.2 years after the
initiation of the Steno-2 study, demonstrated that intensified
multifactorial intervention increases median life-span with 7.9
years and delays incident cardiovascular disease (CVD) with a
median of 8.1 years compared to conventional multifactorial
intervention. Here we aimed to analyze the direct medical costs in
the two original treatment groups during 21.2 years of
follow-up.
Methods: In 1993, 160 Danish patients with type 2
diabetes and microalbuminuria were randomized to receive either
conventional or intensified and target-driven multifactorial
intervention for 7.8 years. Information on direct health costs was
gathered from health registers and any difference of costs in the
two groups was assessed by non-parametric bootstrap t-test
analysis.
Results: Intensified treatment was on average more
expensive regarding drug prescriptions, but less expensive in
primary health sector services (both p<0.0001) and in-patient
admission costs (p=0.02), specifically related to CVD (p<0.0001)
during the entire follow-up period. There was no significant
difference in total costs between the intensified treatment group,
$13.0M and the conventional treatment
group, $12.3M (p=0.19). When further
assessing the cost per patient year there was no significant
difference between the intensified group, $9,648, and the conventional treatment group,
$10,681 (p=0.13).
Conclusion: Over an average follow-up of 21.2 years we
found no significant increase in total costs or in costs per person
year associated with intensified multipronged treatment for 7.8
years when compared to conventional multipronged treatment.
Considering the substantial gain of years of life and health
benefits achieved with intensified treatment we conclude that
intensified multifaceted intervention in high-risk patients with
type 2 diabetes is highly cost-effective in a Danish health care
setting.
Author Disclosures: J. Gaede: None. J. Oellgaard: None.
R. Ibsen: None. P. Gaede: None. E. Noertoft: Employee; Self;
Novo Nordisk A/S. J. Kjellberg: None. O. Pedersen: None.
Press Office in Orlando
June 22 - 26, 2018
407-685-4010
Contact:
Michelle Kirkwood
(703) 299-2053
mkirkwood@diabetes.org
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SOURCE American Diabetes Association