Disclosures: The authors report no relevant financial disclosures.
September 23, 2021
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More diabetes treatment adds life years, reduces costs in low-, middle-income nations

Disclosures: The authors report no relevant financial disclosures.
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Increasing treatment and control of diabetes for people living in low- or middle-income countries could reduce risks for complications and, in turn, save health care dollars, according to findings from a microsimulation.

Justine Davies

“Achieving targets for detecting, treating and controlling diabetes and any associated cardiovascular disease risk factors, like hypertension and high cholesterol, is cost-effective, but the majority of benefits come from improving treatment and control of people who already have had the disease detected,” Justine Davies, MD, MBChB, professor of global health in the Institute of Applied Health Research at the University of Birmingham, told Healio. “The main benefits of achieving the targets comes from reducing CVD outcomes and from treating blood pressure and cholesterol with a statin.”

In a microsimulation, a 60% or 80% increase in treatment and control of diabetes in low- and middle-income countries lowered the rate of diability-adjusted life years lost compared with baseline. Data were derived from Basu S, et al. Lancet Global Health. 2021;doi:10.1016/S2214-109X(21)00340-5.

Davies and colleagues constructed a microsimulation to estimate health care costs and disability-adjusted life years lost to diabetes complications in low- and middle-income countries. Populations were simulated using individual participant data from the WHO STEPwise approach to Surveillance and other surveys from 2006 to 2018. People who had diabetes based on WHO definitions or were taking a diabetes medication in 67 countries across 15 world regions were included. Each person’s 10-year risks for CVD, heart failure, end-stage renal disease, retinopathy and neuropathy and disability-adjusted life years were calculated. In the baseline simulation, the risk for each outcome was estimated given current levels of diagnosis and treatment observed in survey data. Simulated combinations where diagnosis, treatment and control were increased by 60% or 80% of baseline activity were conducted. Cost estimates were calculated using the WHO OneHealth Tool and adjusted to 2020 international dollars.

The simulation included 23,678 people with diabetes (median age, 53 years; 59.8% women). About half of the study cohort was diagnosed with diabetes prior to the survey, and 39.2% were previously diagnosed with hypertension.

At baseline levels of diagnosis, treatment and control, the study cohort had a 10% 10-year risk for CV events, 7.8% risk for neuropathy with pressure sensation loss, 6% risk for retinopathy with severe vision loss and 2.6% risk for congestive heart failure. The risk levels for those already diagnosed or treated were higher than for people newly diagnosed or being treated for diabetes for the first time.

At baseline levels of diagnosis, treatment and control, the study population had a median loss of 1,161 disability-adjusted life years per 1,000 people over 10 years. When treatment and control were increased by 60% in the simulation, there was a reduction in disability-adjusted life years lost to 1,128 per 1,000. A 60% increase in screening further reduced median disability-adjusted life years lost by 5 years per 1,000 people.

When treatment and control were increased by 80%, disability-adjusted life years lost dropped to 1,115 per 1,000 people, with most of the reduction coming from a decrease in CV events. Increasing screening by 80% further reduced disability-adjusted life years lost to 1,097 per 1,000 people, primarily from CV event reductions.

Median population-weight total treatment costs at baseline were $2,222,882 per 1,000 people. When treatment and control were increased by 60%, there was a savings of $1,206 per disability-adjusted life years averted. The figure increased to $1,362 per disability-adjusted life years averted when treatment and control increased by 80%.

“In the future, we aim to understand what factors specifically contribute to the improvement of screening, treatment and control of risk factors for diabetes complications across low- and middle-income countries,” the researchers wrote. “While the data utilized here are cross-sectional, efforts to repeat these analyses are underway, and if augmented by cost and disability assessments, may help to enhance our understanding of what targets to set and how to maximize the potential for strategic investments to improve the population health of those with diabetes.”

For more information:

Justine Davies, MD, MBChB, can be reached at j.davies.6@bham.ac.uk.