THE ECONOMIC-IMPLICATIONS OF IMPLEMENTING EVIDENCE-BASED DIABETIC TREATMENT STRATEGIES

In Type I diabetes, conclusive evidence exists that intensive insulin strategies can achieve normal or near normal blood glucose levels and, as a result, reduce the risk of major complications and produce major benefits in years of life, years of sight, and years free from end-st age renal disease and amputation. The evidence in Type II diabetes is less clear but claims are made that insulin-based strategies should be started earlier, even at initial diagnosis. Intensive strategies have also been shown to improve survival in diabetic patients with acute m yocardial infarction. The economic implications of introducing intensi ve insulin-based strategies have assumed different rates of obesity an d patients currently receiving insulin. Since the costs of an intensiv e insulin-based strategy are approximately 50% more than conventional strategies, the average cost per diabetic patient will increase by hal f the percentage increase in patients receiving intensive therapy. It is argued that the extra costs incurred by the switch in therapy are l ikely to be offset by savings made as a result of reductions in expens ive episodes of care, such as hospitalisation. In addition, evidence e xists to show that such a switch is cost effective in generating addit ional life years and quality adjusted life years for diabetics.