Impact of achieving primary care targets in type 2 diabetes on health outcomes and healthcare costs. Issue 11 (21st July 2019)

• Record Type: Journal Article
• Authors: Keng, Mi Jun; Tsiachristas, Apostolos; Leal, Jose; Gray, Alastair; Mihaylova, Borislava
• Is Part Of: Diabetes, obesity & metabolism. Volume 21:Issue 11(2019)
• Page Start: 2405
• Page End: 2412
• Publication Date: 2019-07-21
• Subjects: diabetes complications -- health economics -- primary care -- type 2 diabetes; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.13821
• Languages: English
• ISSNs: 1462-8902

Abstract

Abstract: Aims: In England and Wales, the National Diabetes Audit (NDA) assesses the quality of management of type 2 diabetes (T2D) in primary care using treatment targets for HbA1c ≤58 mmol/mol, total cholesterol <5 mmol/L and blood pressure ≤140/80 mm Hg. We quantified the impact of variation in achieving these targets on health outcomes and healthcare costs across general practitioners' (GP) practices. Methods: Summary of characteristics of T2D patients from the 2015–2016 NDA were used to generate representative populations of T2D patients. The UKPDS Outcomes Model 2 was used to estimate long‐term health outcomes and healthcare costs. The effects of achieving treatment targets on these outcomes were evaluated using regression models. Results: Achieving more of the HbA1c, cholesterol and blood pressure targets led to a lower incidence of diabetes‐related complications. Approximately 0.5 (95% CI, 0.4‐0.6) quality‐adjusted life years (QALYs) and 0.6 (95% CI, 0.4‐0.7) years of life (LYs) were gained by T2D patients over a lifetime for each additional target met. The projected healthcare cost savings arising from fewer diabetes‐related complications as the result of achieving one, two or three targets compared to none were £859 (95% CI, £553‐£1165), £940 (95% CI, £485‐£1395) and £1037 (95% CI, £414‐£1660) over a patient's lifetime. A typical GP practice in the lowest performing decile (average, 371 T2D patients per practice, with 27% achieving all targets) is projected to gain 201 (95% CI, 123‐279) QALYs and 231 (95% CI, 133‐329) LYs, if all T2D patients achieved all three targets. Conclusions: Substantial gains in health outcomes and reductions in healthcare costs could be achieved with further improvements in attainment of HbA1c, cholesterol and blood pressure targets for T2D patients.