Abstract
Introduction
Type 2 diabetes is a major burden for the payer, however, with proper medication adherence, diet and exercise regime, complication occurrence rates, and consequently costs can be altered.
Aims
The aim of this study was to conduct a cost-effectiveness analysis on real patient data and evaluate which medication adherence or lifestyle intervention is less cost demanding for the payer.
Methods
Medline was searched systematically for published type 2 diabetes interventions regarding medication adherence and lifestyle in order to determine their efficacies, that were then used in the cost-effectiveness analysis. For cost-effectiveness analysis-required disease progression simulation, United Kingdom Prospective Diabetes Study Outcomes model 2.0 and Slovenian type 2 diabetes patient cohort were used. The intervention duration was set to 1, 2, 5, and 10 years. Complications and drug costs in euro (EUR) were based on previously published type 2 diabetes costs from the Health Care payer perspective in Slovenia.
Results
Literature search proved the following interventions to be effective in type 2 diabetes patients: medication adherence, the Mediterranean diet, aerobic, resistance, and combined exercise. The long-term simulation resulted in no payer net savings. The model predicted following quality-adjusted life-years (QALY) gained and incremental costs for QALY gained (EUR/QALYg) after 10 years of intervention: high-efficacy medication adherence (0.245 QALY; 9,984 EUR/QALYg), combined exercise (0.119 QALY; 46,411 EUR/QALYg), low-efficacy medication adherence (0.075 QALY; 30,967 EUR/QALYg), aerobic exercise (0.069 QALY; 80,798 EUR/QALYg), the Mediterranean diet (0.057 QALY; 27,246 EUR/QALYg), and resistance exercise (0.050 QALY; 111,847 EUR/QALYg).
Conclusion
The results suggest that medication adherence intervention is, regarding cost-effectiveness, superior to diet and exercise interventions from the payer perspective. However, the latter could also be utilized by patients without additional costs, but medication adherence intervention requires trained personnel because of its complex structure. Interventions should be performed for >2 years to produce noticeable health/cost results.
Supplementary materials
The following defined daily doses (DDD) and published Health Care payer expenses for different anatomic therapeutic groups (ATC) were utilized for the year 2011 and 2014.Citation1
ATC code C10AA, C10BA; 2011 901,671 DDD/2014 874,060 DDD; 2011 249,911 euro/2014 92,751 euro
ATC code C09A, C09B, C09C; 2011 1,216,343 DDD/2014 960,862 DDD; 2011 53,797 euro/2014 24,804 euro
ATC code C07; 2011 810,770 DDD/2014 772,186 DDD; 2011 91,755 euro/2014 70,754 euro
ATC code B01AC06; 2011 8,957,006 DDD/2014 12,843,360 DDD; 2011 529,577 euro/2014 559,528 euro
ATC code A10B; 2011 741,423 DDD/2014 662,937 DDD; 2011 194,237 euro/2014 163,045 euro
ATC code A10A; 2011 471,572 DDD/2014 575,191 DDD; 2011 502,277 euro/2014 577,481 euro.
Table S1 Costs used and utility values used in the cost-effectiveness analysis
Reference
- Slovenian National Institute of Public HealthDrug consume database from 2001 to 2014 Available from: https://partner.zzzs.si/wps/wcm/connect/94bb0e3f-3d23-4156-926f-47732415acd8/Zdravila+OZZ+2001_2014_i.xlsx?MOD=AJPERES&ContentCache=NONEAccessed December 1, 2015
Disclosure
The authors report no conflicts of interest in this work.