Cost-Savings Associated with Multi-Disciplinary Team Approach for Reducing Macrovascular and Microvascular Complications in Patients with Type 2 Diabetes: A Predictive Model

Figures & data

Figure 1 Our predictive model structure.

Abbreviations: MDT, multidisciplinary team; SBP, systolic blood pressure.

Figure 2 Microsimulation analysis of predicted annual mean incremental cost savings of the multi-disciplinary team approach over 10 years: (A) per T2DM patient; (B) per T2DM patient adjusted for 1% Reduction in HbA1c; (C) per T2DM patient adjusted for 10 mmHg reduction in SBP.

Abbreviations: SBP, systolic blood pressure; T2DM, type 2 diabetes mellitus.

Table 1 Impact of Multidisciplinary Team Approach on Glycemic Control and Blood Pressure Control Among Managed T2DM Patients (N=24755)

Outcomes	Baseline Assessment		After MDT Follow-Up		Mean Change	p-value
	Mean	SD	Mean	SD
HbA1C (%)	10.2	1.3	8.5	1.4	−1.7	< 0.001*
Systolic Blood Pressure (mmHg)	145	17.2	131	14.9	−14	< 0.001*

Note: *P ≤ 0.05 is significant.

Abbreviation: MDT, Multi-Disciplinary Team.

Table 2 Predictive Model for the Incidence and Risk Reduction of Complications per 1.7% Reduction in HbA1c Among T2DM Patients Managed by Multidisciplinary Team Approach

Diabetes-Related Complications and Long-Term Adverse Events	From the Literature				Predicted Risk Reduction in our Model per 1.7% Reduction in HbA1c	Predicted Number of Diabetes-Related Complications
	Average Cumulative Incidence of Complications		Average Risk Reduction per 1% Reduction in HbA1c			Without MDT Approach	With MDT Approach	Net Reduction in Cases
	%	Ref.	%	Ref.
Myocardial infarction	17.1	^Citation6,Citation15	14	^Citation12,Citation15	23.8	4233	3226	1007
Angina	22.8	^Citation14	11	^Citation15	18.7	5644	4589	1055
Heart failure	4	^Citation25	16	^Citation12	27.2	990	721	269
Stroke	3.7	^Citation6	15	^Citation15	25.5	916	683	233
Neuropathy	48.3	^Citation15	27	^Citation15	45.9	11,957	6469	5488
Diabetic foot care	25	^Citation26	25	^Citation15,Citation30	42.5	6189	3559	2630
Amputation	1.2	^Citation27	26	^Citation31,Citation32	44.2	297	166	131
Cataract	24.9	^Citation28	19	^Citation12	32.3	6164	4174	1990
Proliferative Retinopathy	18.3	^Citation15	37	^Citation12	62.9	4530	1681	2849
Nephropathy and ESRD	14.7	^Citation5,Citation16	13	^Citation15,Citation33	22.1	3639	2835	804
Severe hypoglycemia	10.7	^Citation29	31	^Citation34	52.7	2649	1254	1395

Abbreviations: ESRD, End Stage Renal Disease; MDT, Multi-Disciplinary Team; Ref., Reference.

Table 3 Costs Associated with Macrovascular and Microvascular Complications of Diabetes per Case

Complications of Uncontrolled Diabetes	Calculated Costs at the Onset of Complication/Per Case	Average Costs of Complication for Every Subsequent Year/Per Case
		Costs (SR)	Ref.
Myocardial Infarction	42,329	2030	^Citation4
Angina	27,395	2501	^Citation4
Heart Failure	45,260	1978	^Citation4
Stroke	181,041	2515	^Citation4
Neuropathy	15,422	15,422	^Citation5,Citation15
Diabetic Foot Care	99,178	–	–
Amputation	104,726	10,500	FSG-RFHC
Cataract	6466	1180	FSG-RFHC
Proliferative Retinopathy	167,463	1431	^Citation15
Nephropathy and ESRD	60,274	200,000	FSG-RFHC
Hypoglycemic Episodes	5497	–	–

Abbreviations: ESRD, End Stage Renal Disease; Financial Support Group; MDT, Multi-Disciplinary Team; Ref., Reference; RFHC, Riyadh First Health Cluster.

Table 4 Predicted Cost Savings Associated with the Implementation of Multidisciplinary Team Approach Among 24,755 T2DM Patients

Complications of Uncontrolled Diabetes	Predicted Number of Reduced Complicated Cases	Predicted Cost Savings (in Millions)		Total Predicted Cost Savings Per Each Complication (in Million)
		At the Year of Onset of Complication	Over the Subsequent 10 Years of Complication
Myocardial Infarction	1007	42.63	20.44	63.07 SR (16.82 USD)
Angina	1055	28.90	26.39	55.29 SR (14.74 USD)
Heart Failure	269	12.17	5.32	17.49 SR (4.66 USD)
Stroke	233	42.18	5.86	48.04 SR (12.81 USD)
Neuropathy	5488	84,64	846.35	930.99 SR (248.26 USD)
Diabetic Foot Care	2630	260.84	–	260.84 SR (69.56 USD)
Amputation	131	13.72	1.37	15.09 SR (4.02 USD)
Cataract	1990	12.87	23.48	36.35 SR (9.69 USD)
Proliferative Retinopathy	2849	477.1	40.77	517.87 SR (138.1 USD)
Nephropathy and ESRD	804	48.46	1608.00	1656.46 SR (441.72 USD)
Severe Hypoglycemia	1395	7.69	–	7.69 SR (2.04 USD)
Total Predicted Cost Savings (in millions)		1031.18 SR (274.98 USD)	2577.99 SR (687.46 USD)	3609.17 SR (962.44 USD)
Predicted Mean Incremental Cost Savings per each T2DM Patient (in thousands)		41,655 SR (11,108 USD)	104,140 SR (27,770 USD)	145,795 SR (38,878 USD)
Predicted Mean Incremental Cost Savings Adjusted for 1% Reduction in HbA1c (in thousands)		24,502 SR (6534 USD)	61,259 SR (16,335 USD)	85,761 SR (22,869 USD)
Predicted Mean Incremental Cost Savings Adjusted for 10 mmHg Reduction in SBP (in thousands)		29,753 SR (7934 USD)	74,385 SR (19,836 USD)	104,139 SR (27,770 USD)

Abbreviations: ESRD, End Stage Renal Disease; SR, Saudi Riyal; T2DM, Type 2 Diabetes Mellitus; USD, United States Dollar.

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