Lifetime benefits and costs of intensive therapy as practiced in the diabetes control and complications trial

Abstract

Objective.-To examine the cost-effectiveness of alternative approaches to the management of insulin-dependent diabetes mellitus (IDDM). Design.-A Monte Carlo simulation model was developed to estimate the lifetime benefits and costs of conventional and intensive insulin therapy. Data were collected as part of the Diabetes Control and Complications Trial (DCCT) and supplemented with data from other clinical trials and epidemiologic studies. Setting.-Twenty-nine academic medical centers. Patients.-Persons with IDDM in the United States who meet demographic and clinical eligibility criteria for enrollment in the DCCT. Interventions.-Conventional vs intensive diabetes management. Results.-Approximately 120 000 persons with IDDM in the United States meet DCCT eligibility criteria. implementing intensive rather than conventional therapy in this population would result in a gain of 920 000 years of sight, 691 000 years free from end-stage renal disease, 678 000 years free from lower extremity amputation, and 611 000 years of life at an additional cost of $4.0 billion over the lifetime of the population. The incremental cost per year of life gained is $28 661. Conclusions.-Over a lifetime, DCCT-defined intensive therapy reduces complications, improves quality of life, and can be expected to increase length of life. From a health care system perspective, intensive therapy is well within the range of cost-effectiveness considered to represent a good value.