title: Comparative effectiveness of guidelines for the management of hyperlipidemia and hypertension for type 2 diabetes patients.
abstract: BACKGROUND
  Several guidelines to reduce cardiovascular risk in diabetes patients exist in North America, Europe, and Australia. Their ability to achieve this goal efficiently is unclear.
  
  
  RESULTS
  Decision analysis was used to compare the efficiency and effectiveness of international contemporary guidelines for the management of hypertension and hyperlipidemia for patients aged 40-80 with type 2 diabetes. Measures of comparative effectiveness included the expected probability of a coronary or stroke event, incremental medication costs per event, and number-needed-to-treat (NNT) to prevent an event. All guidelines are equally effective, but they differ significantly in their medication costs. The range of NNT to prevent an event was small across guidelines (6.5-7.6 for males and 6.5-7.5 for females); a larger range of differences were observed for expected cost per event avoided (ranges, $117,269-$157,186 for males and $115,999-$163,775 for females). Australian and U.S. guidelines result in the highest and lowest expected costs, respectively.
  
  
  CONCLUSIONS
  International guidelines based on the same evidence and seeking the same goal are similar in their effectiveness; however, there are large differences in expected medication costs.
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, United States of America. shah.nilay@mayo.edu
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mason
authors.forename: Murat
authors.initials: M
authors.lastname: Kurt
authors.forename: Brian T
authors.initials: BT
authors.lastname: Denton
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schaefer
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: Steven A
authors.initials: SA
authors.lastname: Smith
mesh_terms: D001315:Australia; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D048909:Diabetes Complications / Q000188:drug therapy / Q000191:economics*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D019468:Disease Management; D016527:Drug Costs; D005060:Europe; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D008297:Male; D009656:North America; D017410:Practice Guidelines as Topic / Q000592:standards*