Cost-effectiveness of intense insulin treatment after acute myocardial infarction in patients with diabetes mellitus - Results from the DIGAMI study

Aims The aim of the present analysis was to estimate the cost-effectiveness of intense insulin treatment after acute myocardial infarction in patients with diabetes mellitus based on the results of the Diabetes Mellitus Insul in Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. In this study 620 patients with diabetes mellitus and acute myocardial infarction w ere randomized to intense insulin treatment (insulin group) or to serve as controls given standard antidiabetic therapy. Mortality was significantly r educed in the insulin group. Methods and Results The cost-effectiveness ratio was estimated as the incre mental cost per life-year and quality-adjusted life-year gained of intense insulin treatment. The incremental costs were estimated as the difference i n health care costs and indirect costs (labour production) during the first year of follow-up plus the future costs of increased survival. The life-ye ars gained were based on the 5-year long-term follow-up experience and an a ssumed annual 20% mortality risk for all patients thereafter. The health ca re costs were Euro 975 higher in the insulin group during the first year of follow-up, mainly due to a longer period of initial hospitalization relate d to the institution of multidose insulin. The estimated discounted gain in life-years of the insulin treatment was 0.94 years without and 0.66 with q uality of life adjustment, respectively. The cost per life-year gained by i ntense insulin treatment was Euro 16 900 and the cost per quality-adjusted life-year gained was Euro 24 100. Thus the estimated cost-effectiveness rat ios were relatively low. Conclusion The results of the DIGAMI study indicate that intense insulin tr eatment after an acute myocardial infarction in patients with diabetes mell itus has an acceptable level of cost-effectiveness. (C) 2000 The European S ociety of Cardiology.