Effect of Improved Glycemic Control on Health Care Costs and Utilization

Abstract

Cost models have suggested that better glycemic control will lead to reductions in the longer-term economic burden of diabetes by preventing expensive complications.^1-3 Unfortunately, payers and policymakers often demand evidence of more immediate returns on investments before attempting to improve the quality of diabetes care. Two recent studies^4,5 suggest that better glycemic control among type 2 diabetic patients may be followed by health care cost savings within a short time. Gilmer et al,⁴ in a staff-model health maintenance organization (HMO), examined the relationship between baseline levels of hemoglobin A_1c (HbA_1c) among type 2 diabetic patients and health care costs over the ensuing 3 years. For every 1% increase in HbA_1c, they found that health care costs rose significantly over the next 3 years. The authors then used these data to estimate the reduction in health care costs associated with reductions in HbA_1c of 1%. Their model suggests health care cost savings of approximately $400 to $4000 per patient over the ensuing 3 years, with the savings increasing with the level of baseline HbA_1c and the presence of vascular diseases. These relative cost savings are estimates and do not reflect the actual experience of individual patients. Therefore, these data cannot answer 2 critical questions: (1) Will subsequent health care costs decrease if patients achieve better glycemic control? and (2) If so, how long does it take before cost savings are demonstrated?