What impact would pancreatic beta-cell preservation have on life expectancy, quality-adjusted life expectancy and costs of complications in patients with type 2 diabetes? A projection using the CORE Diabetes Model.
OBJECTIVE
Type 2 diabetes is characterised by progressive failure of pancreatic beta-cell function against a background of insulin resistance. Multifactorial interventions, including intensive glycaemic and blood pressure control, reduce the risk of onset and progression of complications. However, current management of type 2 diabetes focuses on treatment of signs and symptoms of disease instead of targeting underlying causes. A number of newer pharmacological interventions, including thiazolidinediones and glucagon-like peptides, have shown early promise in preserving pancreatic beta-cell function. The aim of this study was to investigate the impact of stabilising beta-cell function on long-term outcomes in patients with type 2 diabetes.


METHODS
The CORE Diabetes Model was used to project life expectancy (LE), quality-adjusted LE (QALE) and total lifetime complication costs (TC) for a cohort of newly-diagnosed patients with type 2 diabetes, either with a typical increase of HbA1c over time as observed in the UKPDS, or assuming stabilisation of HbA1c after diagnosis with a hypothetical new treatment, representing beta-cell function stabilisation. Costs due to diabetes-related complications (from a US third-party payer perspective), were discounted at 3% annually. Both non-discounted and discounted (at 3% annually) LE and QALE were calculated. Sensitivity analyses were performed to test the robustness of results.


RESULTS
Over a time period of 50 years, in a cohort with no increase of HbA1c over time, LE and QALE were improved by mean (SD) 1.02 (0.36) and 0.96 (0.25) years, and total costs of complications were reduced by 6,377 dollars (2,568) per patient compared to the cohort with a typical increase in HbA1c over time. Results were robust under a wide range of plausible assumptions.


CONCLUSIONS
New interventions that stabilise pancreatic betacell function may have an important impact on length and quality of life, and lead to reduced costs of complications in patients with type 2 diabetes.
Palmer
Andrew J
AJ
CORE--Center for Outcomes Research, Binningen/Basel, Switzerland. ap@thecenter.ch
Roze
Stéphane
S
Valentine
William J
WJ
Minshall
Michael E
ME
Lammert
Morten
M
Oglesby
Alan
A
Hayes
Clarice
C
Spinas
Giatgen A
GA
D003198:Computer Simulation; D020000:Decision Support Systems, Clinical; D048909:Diabetes Complications / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D007515:Islets of Langerhans / Q000502:physiology*; D008017:Life Expectancy; D017059:Models, Econometric; D011309:Preservation, Biological; D019057:Quality-Adjusted Life Years; D040242:Risk Reduction Behavior