Economic and clinical impact of alternative disease management strategies for secondary prevention in type 2 diabetes in the Swiss setting

Principles: Different intervention strategies for the optimisation of disea se management of diabetes exist and have been shown to increase the proport ion of patients receiving screening and examinations and to improve risk fa ctors such as Hb,,, lipids, and blood pressure. Thus, in the long-term, a d ecrease in diabetic complications and the associated costs could be expecte d. To address this question, the current analysis used a published diabetes simulation model to analyse the long-term clinical and economic implicatio ns of implementing various interventions in the Swiss setting. Methods: Based on data from the literature, the short-term effects on clini cal variables of multifactorial interventions, including screening for neph ropathy and retinopathy, educational programmes and control of cardiovascul ar risk profile were assessed, and a cost-effectiveness analysis in compari son to standard care was performed. Life expectancy (LE) and total lifetime costs (TC) from the perspective of the health insurance payer were calcula ted using a long-term Markov simulation model. Results: The multifactorial intervention led to an improvement in undiscoun ted LE of 0.56 years (LE = 10.73 and 11.29 years for standard care and mult ifactorial intervention respectively), and a reduction in 3%-discounted TC of CHF 7313 (10.7%) per patient compared to current standard practice. Extr apolation to the whole Swiss type 2 diabetes population (285 000) showed ye arly cost savings of CHF 194 million from the multifactorial intervention. Conclusions: The implementation of multifactorial interventions, including improved control of cardiovascular risk factors, combined with early diagno sis and treatment of diabetic complications, could be both cost- and life-s aving in the Swiss setting.