BMJ 2000;320:1373-1378 ( 20 May )

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Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41)

Alastair Gray, director, ^a Maria Raikou, research training fellow, ^b Alistair McGuire, economist, ^b Paul Fenn, economist, ^c Richard Stevens, statistical modeller, ^d Carole Cull, senior statistician, ^d Irene Stratton, senior statistician, ^d Amanda Adler, epidemiologist, ^d Rury Holman, director, ^e Robert Turner, director, ^d on behalf of the United Kingdom Prospective Diabetes Study Group.

^a Health Economics Research Centre, Department of Public Health, University of Oxford, Institute of Health Sciences, Headington OX3 7LF, ^b Department of Economics, City University, London EC1V 0HB, ^c Business School, University of Nottingham, Nottingham NG7 2RD, ^d Diabetes Research Laboratories, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX2 6HE, ^e Diabetes Trials Unit, Nuffield Department of Clinical Medicine

Correspondence to: A Gray alastair.gray{at}ihs.ox.ac.uk

Objective: To estimate the cost effectiveness of conventional versus intensive blood glucose control in patients with type 2 diabetes.
Design: Incremental cost effectiveness analysis alongside randomised controlled trial.
Setting: 23 UK hospital clinic based study centres.
Participants: 3867 patients with newly diagnosed type 2 diabetes (mean age 53 years).
Interventions: Conventional (primarily diet) glucose control policy versus intensive control policy with a sulphonylurea or insulin.
Main outcome measures: Incremental cost per event-free year gained within the trial period.
Results: Intensive glucose control increased trial treatment costs by £695 (95% confidence interval £555 to £836) per patient but reduced the cost of complications by £957 (£233 to £1681) compared with conventional management. If standard practice visit patterns were assumed rather than trial conditions, the incremental cost of intensive management was £478 (£275 to £1232) per patient. The within trial event-free time gained in the intensive group was 0.60 (0.12 to 1.10) years and the lifetime gain 1.14 (0.69 to 1.61) years. The incremental cost per event-free year gained was £1166 (costs and effects discounted at 6% a year) and £563 (costs discounted at 6% a year and effects not discounted).
Conclusions: Intensive blood glucose control in patients with type 2 diabetes significantly increased treatment costs but substantially reduced the cost of complications and increased the time free of complications.

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© BMJ 2000

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Sensitivity to hospital costs

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