Background: This article presents cost-effectiveness analyses of the major diabetes interventions as formulated in the revised Dutch guidelines for diabetes type 2 patients in primary and secondary care. The analyses consider two types of care: diabetes control and the treatment of complications, each at current care level and according to the guidelines.
Methods: A validated probabilistic diabetes model
describes diabetes and its complications over a lifetime
in the Dutch population, computing quality-adjusted life
years and medical costs. Effectiveness data and costs of
diabetes interventions are from observational current
care studies and intensive care experiments. Lifetime
consequences of in total sixteen intervention mixes are
compared with a baseline glycaemic control of 10%
Results: The interventions may reduce the cumulative
incidence of blindness, lower-extremity amputation, and
end-stage renal disease by >70% in primary care and
>60% in secondary care. All primary care guidelines
together add 0.8 quality-adjusted life years per lifetime.
Conclusion: In case of few resources, treating complications according to guidelines yields the most health benefits.
Current care of diabetes complications is inefficient. If
there are sufficient resources, countries may implement
all guidelines, also on diabetes control, and improve
efficiency in diabetes care.