Influence of Diabetes Complications on HbA1c Treatment Goals Among Older U.S. Adults: A Cost-effectiveness Analysis
Open Access
- 17 September 2019
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 42 (11), 2136-2142
- https://doi.org/10.2337/dc19-0381
Abstract
OBJECTIVE Guidelines on the standard care of diabetes recommend that glycemic treatment goals for older adults consider the patient’s complications and life expectancy. In this study, we examined the influence of diabetes complications and associated life expectancies on the cost-effectiveness (CE) of HbA1c treatment goals. RESEARCH DESIGN AND METHODS We used data from the 2011–2016 National Health and Nutrition Examination Survey (NHANES) to generate nationally representative subgroups of older individuals with diabetes with various health states. We used the Centers for Disease Control and Prevention–RTI International diabetes CE model to estimate the long-term consequences of two treatment goals—a stringent control goal (HbA1c 1c $82,413 per QALY). Further, a stringent goal was not cost-effective when an individual had less than 7 years of life remaining. CONCLUSIONS Our findings support the guideline recommendation that glycemic goals for older adults should consider the complexity of their complications and their life expectancy from a CE perspective.Keywords
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