title: Cost-effectiveness of lower targets for blood pressure and low-density lipoprotein cholesterol in diabetes: the Stop Atherosclerosis in Native Diabetics Study (SANDS) .
abstract: BACKGROUND
  The Stop Atherosclerosis in Native Diabetics Study (SANDS) reported cardiovascular benefit of aggressive versus standard treatment targets for both low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) in diabetic individuals.
  
  
  OBJECTIVE
  In this analysis, we examined within trial cost-effectiveness of aggressive targets of LDL-C ≤70 mg/dL and systolic BP ≤115 mmHg versus standard targets of LDL-C ≤100 mg/dL and systolic BP ≤130 mmHg.
  
  
  METHODS
  Randomized, open label blinded-to-endpoint 3-year trial.
  
  
  METHODS
  SANDS clinical trial database, Quality of Wellbeing survey, Centers for Medicare and Medicaid Services, Wholesale Drug Prices.
  
  
  METHODS
  American Indians ≥ age 40 years with type 2 diabetes and no previous cardiovascular events.
  
  
  METHODS
  April 2003 to July 2007.
  
  
  CONCLUSIONS
  Health payer.
  
  
  METHODS
  Participants were randomized to aggressive versus standard groups with treatment algorithms defined for both.
  
  
  METHODS
  Incremental cost-effectiveness.
  
  
  RESULTS
  Compared with the standard group, the aggressive group had slightly lower costs of medical services (-$116) but a 54% greater cost for BP medication ($1,242) and a 116% greater cost for lipid-lowering medication ($2,863), resulting in an increased cost of $3,988 over 3 years. Those in the aggressively treated group gained 0.0480 quality-adjusted life-years (QALY) over the standard group. When a 3% discount rate for costs and outcomes was used, the resulting cost per QALY was $82,589.
  
  
  RESULTS
  The use of a 25%, 50%, and 75% reduction in drug costs resulted in a cost per QALY of $61,329, $40,070, and $18,810, respectively.
  
  
  CONCLUSIONS
  This study was limited by use of a single ethnic group and by its 3-year duration.
  
  
  CONCLUSIONS
  Within this 3-year study, treatment to lower BP and LDL-C below standard targets was not cost-effective because of the cost of the additional medications required to meet the lower targets. With the anticipated availability of generic versions of the BP and lipid-lowering drugs used in SANDS, the cost-effectiveness of this intervention should improve. Published by Elsevier Inc on behalf of the National Lipid Association.
authors.affiliation: Phoenix Indian Medical Center, 4212 N 16th Street, Phoenix, AZ 85016, USA. Charlton.wilson@ihs.gov
authors.forename: Charlton
authors.initials: C
authors.lastname: Wilson
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Huang
authors.forename: Nawar
authors.initials: N
authors.lastname: Shara
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Fleg
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Henderson
authors.forename: Wm James
authors.initials: WJ
authors.lastname: Howard
authors.forename: Heather
authors.initials: H
authors.lastname: Huentelman
authors.forename: Elisa T
authors.initials: ET
authors.lastname: Lee
authors.forename: Mihriye
authors.initials: M
authors.lastname: Mete
authors.forename: Marie
authors.initials: M
authors.lastname: Russell
authors.forename: James M
authors.initials: JM
authors.lastname: Galloway
authors.forename: Angela
authors.initials: A
authors.lastname: Silverman
authors.forename: Mario
authors.initials: M
authors.lastname: Stylianou
authors.forename: Jason
authors.initials: J
authors.lastname: Umans
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
authors.forename: Fawn
authors.initials: F
authors.lastname: Yeh
authors.forename: Robert E
authors.initials: RE
authors.lastname: Ratner
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000517:prevention & control; D008078:Cholesterol, LDL / Q000097:blood; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000191:economics* / Q000627:therapeutic use*; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D014481:United States
chemical_list: D000959:Antihypertensive Agents; D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents