BMJ 2002;325:860 ( 19 October )

Papers

Implementing intensive control of blood glucose concentration and blood pressure in type 2 diabetes in England: cost analysis (UKPDS 63)

Alastair Gray, director, ^a Philip Clarke, research fellow, ^a Andrew Farmer, NHSE R&D clinical scientist, ^b Rury Holman, director, ^c on behalf of the United Kingdom Prospective Diabetes Study (UKPDS) Group.

^a Health Economics Research Centre, Department of Public Health, University of Oxford, Institute of Health Sciences, Oxford OX3 7LF, ^b Department of Primary Health Care, University of Oxford, Institute of Health Sciences, ^c Diabetes Trials Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX2 6HE

Correspondence to: A Gray
alastair.gray{at}ihs.ox.ac.uk

Objective: To estimate the incremental cost of implementing policies for intensive control of blood glucose concentration and blood pressure for all patients with type 2 diabetes in England.
Design: Extrapolation of resource use and cost data derived from a randomised controlled trial.
Setting: General practice, outpatient care, and inpatient care.
Population: Trial population with diagnosed type 2 diabetes in England extrapolated to the population of England.
Main outcome measures: Total costs based on use of healthcare resources including costs of management, treatment, and hospitalisation.
Results: The incremental net annual cost of implementing intensive control of blood glucose and blood pressure to all people with diagnosed type 2 diabetes in England is estimated to be £100.5m ($156m; 159m), which is equivalent to less than 1% of the proposed additional annual expenditure on the NHS in 2001-5. This estimate varied in sensitivity analyses from £67m to £121m.
Conclusions: Policies to improve control of blood glucose and blood pressure of people with type 2 diabetes are effective in reducing complications associated with the disease and are also cost effective. The total cost represents a small fraction of the NHS's spending plans.

What is already known on this topic The United Kingdom Prospective Diabetes Study (UKPDS) has shown that policies of intensive control of blood glucose concentration and blood pressure for people with type 2 diabetes are cost effective interventions Current levels of diabetes care in England need to be improved, but the total cost and the implications for NHS staffing are unknown What this study adds Implementing the main findings of the UKPDS to all people with diagnosed type 2 diabetes in England would have a net annual cost of around £100m, which equates to 1% of the planned increase in annual expenditure on the NHS over the period 2001-5 About 720 additional staff would be required to implement these control policies, especially specialist nurses and practice nurses The advent of primary care trusts and the national service framework for diabetes should create new incentives and mechanisms to adopt these improved standards

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