The cost-effectiveness of different management strategies for Type I diabetes: a Swiss perspective

Aims/hypothesis. A computer model was developed to determine the health out comes and economic consequences of different combinations of diabetes inter ventions in newly diagnosed patients with Type I (insulin-dependent) diabet es in Switzerland. Methods. We modelled seven complications of diabetes: hypoglycaemia, ketoac idosis, acute myocardial infarction, stroke, lower extremity amputation, ne phropathy, and retinopathy. Transition probabilities and costs were taken f rom published literature. The Swiss health insurance payer perspective was taken. Various combinations of diabetes management strategies, including in tensive or conventional insulin therapy and screening and treatment strateg ies for renal and eye disease were defined. Life expectancy, cumulative inc idences of complications, and mean expected total lifetime costs per patien t were calculated under six different management strategies. Incremental co st-effectiveness ratios were calculated in terms of costs per life-year gai ned compared with conventional insulin therapy alone. Results. The addition of screening for microalbuminuria and retinopathy fol lowed by appropriate treatment, if detected, were cost saving, with reducti on in cumulative incidence of end stage renal disease and blindness respect ively, and, in the case of microalbuminuria screening and treatment, an imp rovement in life expectancy. Intensive therapy improved life expectancy but increased total lifetime costs. Conclusion/interpretation. Optimal management of Type I diabetic patients, including secondary and tertiary prevention, leads to reduced complications and improved life expectancy, with the increased costs of prevention offse t to varying degrees by cost savings due to complications avoided.