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Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41)

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7246.1373 (Published 20 May 2000) Cite this as: BMJ 2000;320:1373
  1. Alastair Gray, director (alastair.gray{at}ihs.ox.ac.uk)a,
  2. Maria Raikou, research training fellowb,
  3. Alistair McGuire, economistb,
  4. Paul Fenn, economistc,
  5. Richard Stevens, statistical modellerd,
  6. Carole Cull, senior statisticiand,
  7. Irene Stratton, senior statisticiand,
  8. Amanda Adler, epidemiologistd,
  9. Rury Holman, directore,
  10. Robert Turner, directord the United Kingdom Prospective Diabetes Study Group
  1. a Health Economics Research Centre, Department of Public Health, University of Oxford, Institute of Health Sciences, Headington OX3 7LF
  2. b Department of Economics, City University, London EC1V 0HB
  3. c Business School, University of Nottingham, Nottingham NG7 2RD
  4. d Diabetes Research Laboratories, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX2 6HE
  5. e Diabetes Trials Unit, Nuffield Department of Clinical Medicine
  1. Correspondence to: A Gray
  • Accepted 7 February 2000

Abstract

Objective: To estimate the cost effectiveness of conventional versus intensive blood glucose control in patients with type 2 diabetes.

Design: Incremental cost effectiveness analysis alongside randomised controlled trial.

Setting: 23 UK hospital clinic based study centres.

Participants: 3867 patients with newly diagnosed type 2 diabetes (mean age 53 years).

Interventions: Conventional (primarily diet) glucose control policy versus intensive control policy with a sulphonylurea or insulin.

Main outcome measures: Incremental cost per event-free year gained within the trial period.

Results: Intensive glucose control increased trial treatment costs by £695 (95% confidence interval £555 to £836) per patient but reduced the cost of complications by £957 (£233 to £1681) compared with conventional management. If standard practice visit patterns were assumed rather than trial conditions, the incremental cost of intensive management was £478 (-£275 to £1232) per patient. The within trial event-free time gained in the intensive group was 0.60 (0.12 to 1.10) years and the lifetime gain 1.14 (0.69 to 1.61) years. The incremental cost per event-free year gained was £1166 (costs and effects discounted at 6% a year) and £563 (costs discounted at 6% a year and effects not discounted).

Conclusions: Intensive blood glucose control in patients with type 2 diabetes significantly increased treatment costs but substantially reduced the cost of complications and increased the time free of complications.

Footnotes

  • Funding Glaxo Wellcome, SmithKline Beecham, Pfizer, Zeneca, Pharmacia Upjohn, Novo Nordisk, Bayer, Roche, and UK Department of Health. RS is supported by a Wellcome Trust fellowship (grant No 054470/Z/98/Z/DG/NOS/FH). The main study was supported by grants from the UK Medical Research Council, British Diabetic Association, UK Department of Health, US National Eye Institute and National Institute of Diabetes, Digestive and Kidney Disease in the National Institutes of Health, British Heart Foundation, Novo Nordisk, Bayer, Bristol-Myers Squibb, Hoechst, Lilly, Lipha and Farmitalia Carlo Erba.

  • Competing interests RH has received research for members of staff and fees for consulting and speaking, CC has received support for the cost of attending conferences, and AA has received fees for consulting from many of the companies who supported the study. AG has received support for attending conferences from Lipha.

  • Embedded Image The centres of the UK Prospective Diabetes Study Group, methods used to test model validity, and results of secondary analysis are given on the BMJ's website

  • Accepted 7 February 2000
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