The net value of health care for patients with type 2 diabetes, 1997 to 2005.
BACKGROUND
The net economic value of increased health care spending remains unclear, especially for chronic diseases.


OBJECTIVE
To assess the net value of health care for patients with type 2 diabetes.


METHODS
Economic analysis of observational cohort data.


METHODS
Mayo Clinic, Rochester, Minnesota, a not-for-profit integrated health care delivery system.


METHODS
613 patients with type 2 diabetes.


METHODS
Changes in inflation-adjusted annual health care spending and in health status between 1997 and 2005 (with health status defined as 10-year cardiovascular risk), holding age and diabetes duration constant across the observation period ("modifiable risk"), and simulated outcomes for all diabetes complications based on the UKPDS (United Kingdom Perspective Diabetes Study) Outcomes Model. Net value was estimated as the present discounted monetary value of improved survival and avoided treatment spending for coronary heart disease minus the increase in annual spending per patient.


RESULTS
Assuming that 1 life-year is worth $200,000 and accounting for changes in modifiable cardiovascular risk, the net value of changes in health care for patients with type 2 diabetes was $10,911 per patient (95% CI, -$8480 to $33,402) between 1997 and 2005, a positive dollar value that suggests the value of health care has improved despite increased spending. A second approach based on diabetes complications yielded a net value of $6931 per patient (CI, -$186,901 to $211,980).


CONCLUSIONS
The patient population was homogeneous and small, and the wide CIs of the estimates are compatible with a decrease as well as an increase in value.


CONCLUSIONS
The economic value of improvements in health status for patients with type 2 diabetes seems to exceed or equal increases in health care spending, suggesting that those increases were worth the extra cost. However, the possibility that society is getting less value for its money could not be statistically excluded, and there is opportunity to improve the value of diabetes-related health care.


BACKGROUND
None.
Eggleston
Karen N
KN
Stanford University Shorenstein Asia-Pacific Research Center, Encina Hall E301, Stanford, CA 94305-6055, USA. karene@stanford.edu
Shah
Nilay D
ND
Smith
Steven A
SA
Wagie
Amy E
AE
Williams
Arthur R
AR
Grossman
Jerome H
JH
Berndt
Ernst R
ER
Long
Kirsten Hall
KH
Banerjee
Ritesh
R
Newhouse
Joseph P
JP
D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000191:economics*; D003925:Diabetic Angiopathies / Q000517:prevention & control; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care / Q000379:methods; D012307:Risk Factors