A managed care perspective O R I G I N A L A R T I C L EOBJECTIVE -There are limited data relating glycemic control to medical costs among patients with diabetes. The goal of this study was to examine the potential impact of improved glycemic control on selected short-term complications of diabetes and associated costs in a managed care setting.RESEARCH DESIGN AND METHODS -Using a retrospective cohort design and automated databases from 1 January 1994 to 30 June 1998, adult members of the Fallon Clinic who were diagnosed with diabetes were identified and assigned to one of three study groups based on each patient' s mean HbA 1c level: good control (Ͻ8%), fair control (8-10%), and poor control (Ͼ10%) groups. Inpatient (hospital or skilled nursing facility) admissions for selected acute (short-term) complications, represented by selected infections, hyperglycemia, hypoglycemia, and electrolyte disturbances, and the associated medical charges were evaluated across the three HbA 1c groups. Multivariate analyses were used to control for differences in several potential confounding factors among the study groups. All findings were expressed on a 3-year basis.RESULTS -Of 2,394 patients with diabetes, ϳ10% (251) had at least one inpatient stay for a short-term complication, accounting for 447 admissions. Over 3 years, the adjusted rate of inpatient treatment ranged from 13 per 100 patients with good glycemic control to 16 per 100 patients with fair glycemic control and 31 per 100 patients with poor glycemic control (P Ͻ 0.05). The corresponding mean adjusted charges were approximately $970, $1,380, and $3,040, respectively. Among the 30% of the study population with long-term diabetic complications, the results were more marked; the adjusted admissions per 100 patients (mean charges) were estimated to be 30 ($2,610), 38 ($3,810), and 74 ($8,320) over 3 years for patients with an HbA 1c of Ͻ8, 8-10, and Ͼ10%, respectively.CONCLUSIONS -In typical practice, better glycemic control is associated with a reduced rate of admission for selected short-term complications and, therefore, reduced medical charges for these complications over a 3-year period. The potential short-term economic benefits are important to consider when making decisions regarding the adoption and use of new interventions for the management of diabetes.

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T o date there have been few studies focusing on economic assessments of fibrate therapy in the management of coronary heart disease (CHD), particularly in patients with type 2 diabetes. A cost-effectiveness model for an economic analysis was established by an assessment of 'cost per CHD event avoided' for fibrate therapy. This model was derived from: i) data on CHD events in patients with and without diabetes from randomised controlled trials of lipid-lowering agents, ii) comparisons of fibrate and HMG CoA reductase inhibitor (statin) treatment compared to no treatment and iii) current UK-based drug and clinical event costs. Treatment benefits over a five-year period were calculated, and the sensitivity of the model to the individual variables tested.Fibrate therapy was substantially more cost-effective than statin therapy in patients with diabetes. Economic costings for fenofibrate, as the index fibrate commonly used in the UK, confirmed an annual cost of £2,642-£3,700 per CHD event avoided over a five-year assessment period. Cost-effectiveness ratios derived in the economic model demonstrated that fibrate therapy was equally effective as statin therapy, but at a 54% reduction in annual cost. Current and future CHD treatment guidelines should incorporate pharmacoeconomic data for fibrate as well as statin therapy. Br J Diabetes Vasc Dis 2003;3:124-30

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