Optimal allocation of resources across four interventions for type 2 diabetes.
BACKGROUND
Several interventions can be applied to prevent complications of type 2 diabetes. This article examines the optimal allocation of resources across 4 interventions to treat patients newly diagnosed with type 2 diabetes. The interventions are intensive glycemic control, intensified hypertension control, cholesterol reduction, and smoking cessation.


METHODS
A linear programming model was designed to select sets of interventions to maximize quality-adjusted life years (QALYs), subject to varied budget and equity constraints.


RESULTS
For no additional cost, approximately 211,000 QALYs can be gained over the lifetimes of all persons newly diagnosed with diabetes by implementing interventions rather than standard care. With increased availability of funds, additional health benefits can be gained but with diminishing marginal returns. The impact of equity constraints is extensive compared to the solution with the same intervention costs and no equity constraint. Under the conditions modeled, intensified hypertension control and smoking cessation interventions were provided most often, and intensive glycemic control and cholesterol reduction interventions were provided less often.


CONCLUSIONS
A resource allocation model identifies trade-offs involved when imposing budget and equity constraints on care for individuals with newly diagnosed diabetes.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D017046:Cost Savings; D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000517:prevention & control*; D018450:Disease Progression; D017048:Health Care Costs / Q000706:statistics & numerical data; D015276:Health Care Rationing / Q000191:economics / Q000592:standards*; D006295:Health Resources / Q000191:economics / Q000592:standards*; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000517:prevention & control*; D006973:Hypertension / Q000150:complications / Q000517:prevention & control*; D016014:Linear Models; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation / Q000191:economics; D000074606:Smoking Prevention; D016896:Treatment Outcome
D001786:Blood Glucose