Cost-effectiveness of primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes: results from the Collaborative Atorvastatin Diabetes Study (CARDS)

Raikou, Maria; McGuire, Alistair; Colhoun, Helen M.; Betteridge, D. J.; Durrington, Paul N.; Hitman, G. A.; Neil, H. A. W.; Livingstone, Shona; Charlton-Menys, V.; Fuller, John; Investigators, Cards

doi:10.1007/s00125-006-0561-4

Cited by 39 publications

(32 citation statements)

References 20 publications

(17 reference statements)

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“…Table 1 shows the detailed description of the CE studies that we included according to intervention type (13–70). We first grouped similar interventions together, then arranged them chronologically and by the first author's last name.…”

Section: Resultsmentioning

confidence: 99%

Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review

et al. 2010

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OBJECTIVETo synthesize the cost-effectiveness (CE) of interventions to prevent and control diabetes, its complications, and comorbidities.RESEARCH DESIGN AND METHODSWe conducted a systematic review of literature on the CE of diabetes interventions recommended by the American Diabetes Association (ADA) and published between January 1985 and May 2008. We categorized the strength of evidence about the CE of an intervention as strong, supportive, or uncertain. CEs were classified as cost saving (more health benefit at a lower cost), very cost-effective (≤$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001 to $50,000 per LYG or QALY), marginally cost-effective ($50,001 to $100,000 per LYG or QALY), or not cost-effective (>$100,000 per LYG or QALY). The CE classification of an intervention was reported separately by country setting (U.S. or other developed countries) if CE varied by where the intervention was implemented. Costs were measured in 2007 U.S. dollars.RESULTSFifty-six studies from 20 countries met the inclusion criteria. A large majority of the ADA recommended interventions are cost-effective. We found strong evidence to classify the following interventions as cost saving or very cost-effective: (I) Cost saving— 1) ACE inhibitor (ACEI) therapy for intensive hypertension control compared with standard hypertension control; 2) ACEI or angiotensin receptor blocker (ARB) therapy to prevent end-stage renal disease (ESRD) compared with no ACEI or ARB treatment; 3) early irbesartan therapy (at the microalbuminuria stage) to prevent ESRD compared with later treatment (at the macroalbuminuria stage); 4) comprehensive foot care to prevent ulcers compared with usual care; 5) multi-component interventions for diabetic risk factor control and early detection of complications compared with conventional insulin therapy for persons with type 1 diabetes; and 6) multi-component interventions for diabetic risk factor control and early detection of complications compared with standard glycemic control for persons with type 2 diabetes. (II) Very cost-effective— 1) intensive lifestyle interventions to prevent type 2 diabetes among persons with impaired glucose tolerance compared with standard lifestyle recommendations; 2) universal opportunistic screening for undiagnosed type 2 diabetes in African Americans between 45 and 54 years old; 3) intensive glycemic control as implemented in the UK Prospective Diabetes Study in persons with newly diagnosed type 2 diabetes compared with conventional glycemic control; 4) statin therapy for secondary prevention of cardiovascular disease compared with no statin therapy; 5) counseling and treatment for smoking cessation compared with no counseling and treatment; 6) annual screening for diabetic retinopathy and ensuing treatment in persons with type 1 diabetes compared with no screening; 7) annual screening for diabetic retinopathy and ensuing treatment in persons with type 2 diabetes compared with no screening; and 8) immediate vitrectomy to treat ...

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Section: Resultsmentioning

confidence: 99%

Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review

et al. 2010

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“…Second, it was quite difficult to clearly define "diabetes-related" care. Most studies that adopted the latter approach only included the costs related to the care of selected diabetes-related complications (37-39) and acknowledged this as a limitation (34). Although the usual-care group had slightly higher health service utilization and costs at baseline than the RAMP-DM group (1,359 vs. 1,347 USD), the difference could not account for the usual-care group's substantially higher costs than the RAMP-DM group in the subsequent years.…”

Section: Discussionmentioning

confidence: 99%

Five-Year Cost-effectiveness of the Multidisciplinary Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM)

et al. 2017

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OBJECTIVETo estimate the cost-effectiveness of the multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus (RAMP-DM) in primary care patients with type 2 diabetes in comparison with usual primary care in a cohort with 5 years' follow-up. RESEARCH DESIGN AND METHODSWe conducted a prospective cohort study among 17,140 propensity score-matched participants in RAMP-DM and those under usual primary care. The effectiveness measures were cumulative incidences of complications and all-cause mortality over 5 years. In a bottom-up approach, we estimated the program costs of RAMP-DM and health service utilization from the public health service provider's perspective. The RAMP-DM program costs included the setup costs, ongoing intervention costs, and central administrative costs. We calculated the incremental cost-effectiveness ratio by dividing the incremental costs by the incremental effectiveness of the RAMP-DM group compared with those of the usual-care group. RESULTSThere were significantly lower cumulative incidences of individual on any complications (15.34% vs. 28.65%, P < 0.001) and all-cause mortality (7.96% vs. 21.35%, P < 0.001) in the RAMP-DM group compared with the usual-care group. The mean program cost of RAMP-DM was 157 U.S. dollars (range 66-209) per participant over 5 years. The costs of health service utilization among participants in RAMP-DM group was 7,451 USD less than that of the usual-care group, resulting in a net savings of 7,294 USD per individual. CONCLUSIONSRAMP-DM added to usual primary care was a cost-saving intervention in managing diabetes in patients over 5 years. These findings support the integration of RAMP-DM as part of routine primary care for all patients with diabetes.The prevalence of diabetes is increasing globally. The latest estimation shows that there were 415 million people with diabetes all over the world by 2015, and the number is estimated to climb to 642 million by 2040 (1). China is among the countries with the highest diabetes prevalence: 11.6% among the adult population (2). Management of diabetes and diabetes-related complications posts a huge medical, social, and financial burden. It cost ;727 billion USD in total to manage diabetes in 2015, taking

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“…26 There is some evidence to suggest that more high-quality care for chronic conditions can reduce overall costs 27 and more evidence to suggest that it is costeffective. 28,29 Critics of CDHPs worry that because enrollees with chronic conditions have more direct financial responsibility for needed care, they may forgo important services and therefore be at risk for future complications. This study provides empirical data to test whether CDHPs have a negative effect on the quality of care received by people with chronic conditions.…”

Section: Contribution To the Literaturementioning

confidence: 99%

Comparing Quality of Care Between a Consumer-Directed Health Plan and a Traditional Plan: An Analysis of HEDIS Measures Related to Management of Chronic Diseases

Wilson

Rodin

Garrett

et al. 2009

Population Health Management

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A cross-sectional, retrospective medical and pharmaceutical claims data analysis was conducted to determine if Healthcare Effectiveness Data and Information Set (HEDIS) measures related to care for chronic conditions differed between enrollees in a traditional comprehensive major medical plan (CMM) and a consumer-directed health plan (CDHP). Eleven HEDIS measures for 2006 were compared for CMM and CDHP enrollees in a health plan. Measures included care for persons with diabetes, asthma, depression, cardiovascular disease, and low back pain, and for persons taking persistent medications for specific conditions. In the CMM population, 1,238,949 members were eligible to be included; 131,763 members in the CDHP population were eligible. Statistical significance testing was performed. As measured by HEDIS, CDHP enrollees received higher quality of care than did CMM enrollees in areas related to low back pain, and eye exams and nephropathy screening for persons with diabetes. No significant differences were found between CDHP enrollees and CMM enrollees for measures describing medication management for persons with depression and asthma, annual monitoring for persons taking persistent medications, cholesterol management for persons with cardiovascular disease, or HbA1c testing and low-density lipoprotein screening for persons with diabetes. Enrollees in CDHPs who have chronic conditions received care at levels of quality equal to or better than CMM enrollees. The potential for increased financial responsibility in the CDHP plan did not appear to deter those enrollees from pursuing necessary care. Future research should control for the demographic factors thought to influence both selection into a plan design and quality of care.

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Cost-effectiveness of primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes: results from the Collaborative Atorvastatin Diabetes Study (CARDS)

Cited by 39 publications

References 20 publications

Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review

Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review

Five-Year Cost-effectiveness of the Multidisciplinary Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM)

Comparing Quality of Care Between a Consumer-Directed Health Plan and a Traditional Plan: An Analysis of HEDIS Measures Related to Management of Chronic Diseases

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