July 12, 2011

Study Determines Cost-Effective Means to Prevent Diabetes

Sean Sullivan

Professor of Pharmacy Sean Sullivan is the lead author on a study out this week that shows that the cost-effectiveness of type 2 diabetes prevention can be significantly improved when a diabetes risk score (DRS) is used to identify patients at highest risk for diabetes.

The study results were published in the July issue of the Journal of Medical Economics, in a paper entitled, “Cost-Effectiveness of Risk Stratification for Preventing Type 2 Diabetes Using A Multi-Marker Diabetes Risk Score.” Sullivan, the director of the UW Pharmaceutical Outcomes Research and Policy Program, wrote the piece with UW Professor of Pharmacy Lou Garrison as well as with researchers from California and Switzerland.

The publication reported results from a study comparing the costs and benefits of using a multi-marker DRS to identify individuals at high risk of developing type 2 diabetes within a patient population that has impaired fasting glucose (IFG), a well-known risk factor for diabetes. Data showed that combining the use of IFG plus the DRS improved identification among those at highest risk of developing type 2 diabetes compared to using IFG alone, and that over time, use of theDRS could produce significant health economic benefits by reducing healthcare expenditures for the prevention and treatment of type 2 diabetes.

“Our data show that the cost-effectiveness of diabetes prevention programs can be improved by using the PreDx DRS of to identify those patients at highest risk for diabetes,” said Dr. Sullivan.

The PreDx DRS is a specific multi-marker fasting blood test that assesses markers of inflammation, fat cell function, and glucose metabolism, and categorizes individuals as low, moderate, or high risk for diabetes conversion within 5 years. The test can be used to identify patients at risk for diabetes who are most likely to benefit from appropriate medical or lifestyle intervention, to reduce their risk of progressing to diabetes over the long term, and to monitor and potentially improve treatment outcomes.

The aim of this study was to compare the potential costs and health benefits of two approaches for identifying those at high risk of developing type 2 diabetes for entry into a diabetes prevention program. The first approach identified patients with IFG as high-risk. The second approach used the DRS to further stratify patients with IFG into high-risk and moderate-risk groups.

The potential cost-effectiveness of each of these two approaches was estimated using models that simulated the incidence and disease progression of diabetes and the consequent costs and quality-adjusted life expectancy comparing alternative approaches for identifying patients to be in a diabetes prevention and surveillance program. The perspective of a United States U.S. healthcare system was used, i.e., including only direct medical costs. The cost-effectiveness of alternative scenarios was examined over 5 to 10-year time horizons, with 5 years as the base-case horizon.

Results showed that, among other things, stratification of IFG patients by the DRS method leads to improved identification of those at highest risk for development of diabetes. At 5 years, the number needed to treat in the IFG-only approach was 39 patients to prevent one case of diabetes compared to 15 patients who were needed to treat in the approach that included IFG and the DRS.

“As compared to treating all patients with IFG – an approach that is unlikely to result in net cost savings in this population – risk stratification using the DRS may ultimately result in cost reductions for the health care system,” said Sean Sullivan. “These findings are especially important given the fact that current risk assessment tools identify large segments of the population as ‘at risk’ for diabetes, making it difficult to implement cost-effective diabetes prevention programs. Clearly, more accurate tools for identifying those at highest risk for diabetes, such as the PreDx DRS, are needed to advance diabetes prevention, improve health outcomes and lower healthcare costs.”

For More Information:
Read the Tethys press release about this study.

July 12, 2011

 

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