title: Economic and clinical impact of alternative disease management strategies for secondary prevention in type 2 diabetes in the Swiss setting.
abstract: BACKGROUND
  Different intervention strategies for the optimisation of disease management of diabetes exist and have been shown to increase the proportion of patients receiving screening and examinations and to improve risk factors such as HbA1c, lipids, and blood pressure. Thus, in the long-term, a decrease in diabetic complications and the associated costs could be expected. To address this question, the current analysis used a published diabetes simulation model to analyse the long-term clinical and economic implications of implementing various interventions in the Swiss setting.
  
  
  METHODS
  Based on data from the literature, the short-term effects on clinical variables of multifactorial interventions, including screening for nephropathy and retinopathy, educational programmes and control of cardiovascular risk profile were assessed, and a cost-effectiveness analysis in comparison to standard care was performed. Life expectancy (LE) and total lifetime costs (TC) from the perspective of the health insurance payer were calculated using a long-term Markov simulation model.
  
  
  RESULTS
  The multifactorial intervention led to an improvement in undiscounted LE of 0.56 years (LE = 10.73 and 11.29 years for standard care and multifactorial intervention respectively), and a reduction in 3%-discounted TC of CHF 7313 (10.7%) per patient compared to current standard practice. Extrapolation to the whole Swiss type 2 diabetes population (285,000) showed yearly cost savings of CHF 194 million from the multifactorial intervention.
  
  
  CONCLUSIONS
  The implementation of multifactorial interventions, including improved control of cardiovascular risk factors, combined with early diagnosis and treatment of diabetic complications, could be both cost- and life-saving in the Swiss setting.
authors.affiliation: Institute for Medical Informatics and Biostatistics (IMIB), Riehen, Switzerland. gozzoli@econophone.ch
authors.forename: V
authors.initials: V
authors.lastname: Gozzoli
authors.forename: A J
authors.initials: AJ
authors.lastname: Palmer
authors.forename: A
authors.initials: A
authors.lastname: Brandt
authors.forename: G A
authors.initials: GA
authors.lastname: Spinas
mesh_terms: D000529:Complementary Therapies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000517:prevention & control / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology