Skip to main content
Log in

The Economics of Screening and Treatment in Type 2 Diabetes Mellitus

  • Review Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

A systematic review of the literature was conducted to identify articles on the economics of type 2 diabetes mellitus. Articles were classified into two main categories: cost/burden-of-illness studies of type 2 diabetes and economic evaluations of type 2 diabetes interventions. This systematic review was supplemented by an overview of the findings relating to economic evaluations of associated diabetic complications. A number of conclusions emerge from this review, the most important of which is that intensive treatment of patients with type 2 diabetes appears to be relatively cost effective compared with more conservative strategies. This finding reflects the cost offsets that arise from the range and degree of complications attributable to diabetes. Primary prevention of type 2 diabetes also appears to be cost effective, particularly in high-risk groups. The evidence on screening for type 2 diabetes is less conclusive and further economic analysis is required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III
Fig. 1

Similar content being viewed by others

References

  1. Harris M. Medical care for patients with diabetes: epidemiological aspects. Ann Intern Med 1996; 124: 117–27

    PubMed  CAS  Google Scholar 

  2. Alberti K. Problems related to definitions and epidemiology of type 2 (non-insulin dependent) diabetes mellitus: studies throughout the world. Diabetologia 1993; 36: 978–84

    Article  PubMed  CAS  Google Scholar 

  3. Alwin A, King H. Diabetes in the east Mediterranean region. Diabet Med 1995; 12: 1057–8

    Article  Google Scholar 

  4. King H, Rewers M. Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. Diabetes Care 1993; 16: 157–77

    Article  PubMed  CAS  Google Scholar 

  5. UK Prospective Diabetes Study Group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–53

    Article  Google Scholar 

  6. Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with NIDDM: a randomised prospective 6-year study. Diabetes Res Clin Pract 1995; 28: 103–17

    Article  PubMed  CAS  Google Scholar 

  7. Gulliford M. Design of cost-effective packages of care for non-insulin dependent diabetes mellitus. Int J Technol Assess Health Care 1997; 13: 395–410

    Article  PubMed  CAS  Google Scholar 

  8. Marks L. Counting the cost: the real impact of non-insulin dependent diabetes. London: King’s Fund Policy Institute, 1995

    Google Scholar 

  9. Jonsson B, Krans H. The social and cost implications of type II diabetes. Pharmacoeconomics 1995; 8 Suppl. 1: s1-94

    Google Scholar 

  10. NHS Economic Evaluation Database (NHS FED). Available from URL: http://nhscrd.york.ac.uk/nhsdhp.htm [Accessed 2003 Apr 30]

  11. Brown J, Nichols G, Glauber H, et al. Type 2 diabetes: incremental medical care costs during the first 8 years after diagnosis. Diabetes Care 1999; 22: 1116–24

    Article  PubMed  CAS  Google Scholar 

  12. Brown J, Pedula K, Bakst A. The progressive cost of complications in type 2 diabetes mellitus. Arch Intern Med 1999; 159: 1873–80

    Article  PubMed  CAS  Google Scholar 

  13. Evans J, MacDonald T, Leese G, et al. Impact of type 1 and type 2 diabetes on patterns and costs of drug prescribing. Diabetes Care 2000; 23: 770–4

    Article  PubMed  CAS  Google Scholar 

  14. Henriksson F, Agardh C, Berne C, et al. Direct medical costs for patients with type 2 diabetes in Sweden. J Intern Med 2000; 248:387–96

    Article  PubMed  CAS  Google Scholar 

  15. O’Brien J, Shomphe L, Kavanagh P, et al. Direct medical costs of complications resulting from type 2 diabetes in the US. Diabetes Care 1998; 21: 1122–8

    Article  PubMed  Google Scholar 

  16. Zimmet P, McCarthy D. The NIDDM epidemic: global estimates and projections: a look into the crystal ball. IDF Bull 1995; 40: 8–16

    Google Scholar 

  17. Alberti K. The costs of NIDDM. Diabet Med 1997; 14: 7–9

    Article  PubMed  CAS  Google Scholar 

  18. Eastman R, Javitt J, Herman W, et al. Model of complications of NIDDM I: Model construction and assumptions. Diabetes Care 1997; 20: 725–34

    Article  PubMed  CAS  Google Scholar 

  19. Eastman R, Javitt J, Herman W, et al. Model of complications of NIDDM II: Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia. Diabetes Care 1997; 20: 735–44

    Article  PubMed  CAS  Google Scholar 

  20. Engelgau M, Venkat Narayan K, Thomson T, et al. The cost-effectiveness of screening for type 2 diabetes. JAMA 1998; 280: 1757–63

    Article  Google Scholar 

  21. Franz M, Splett P, Monk A, et al. Cost-effectiveness of medical nutrition therapy provided by dieticians for persons with non-insulin-dependent diabetes mellitus. J Am Diet Assoc 1995; 95: 1018–24

    Article  PubMed  CAS  Google Scholar 

  22. Golan L, Birkmeyer J, Welch G. The cost-effectiveness of treating all patients with type 2 diabetes with angiotensin-converting enzyme inhibitors. Ann Intern Med 1999; 131: 660–7

    PubMed  CAS  Google Scholar 

  23. Segal L, Dalton A, Richardson J. Cost-effectiveness of the primary prevention of non-insulin dependent diabetes mellitus. Health Promot Internation 1998; 13: 197–208

    Article  Google Scholar 

  24. Wake N, Hisahige A, Katayama T, et al. Cost-effectiveness of intensive insulin therapy for type 2 diabetes: a 10-year follow-up of the Kumamoto study. Diabetes Res Clin Pract 2000; 48: 201–10

    Article  PubMed  CAS  Google Scholar 

  25. UKPDS Group. Cost-effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes (UKPDS 40). BMJ 1998; 317: 720–6

    Article  Google Scholar 

  26. Gray A, Raikou M, McGuire A, et al. Cost-effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41). BMJ 2000; 320: 1373–8

    Article  PubMed  CAS  Google Scholar 

  27. Clarke P, Gray A, Adler A, et al. Cost-effectiveness analysis of intensive blood-glucose control with metformin in overweight patients with type II diabetes (UKPDS 51). Diabetologia 2001; 44: 298–304

    Article  PubMed  CAS  Google Scholar 

  28. Gray A, Clarke P, Raikou M, et al. An economic evaluation of atenolol versus captopril in patients with type 2 diabetes (UKPDS 54). Diabet Med 2001; 18: 438–44

    Article  PubMed  CAS  Google Scholar 

  29. Eriksson K, Lindegarde F. Prevention of type 2 (non-insulin dependent) diabetes mellitus by diet and physical exercise. The 6-year Malmo feasibility study. Diabetologia 1992; 34: 891–8

    Article  Google Scholar 

  30. Franz M, Monk A, Barry B, et al. Effectiveness of medical nutrition therapy provided by dietitians in the management of diabetes mellitus: an RCT. J Am Diet Assoc 1995; 95: 1009–17

    Article  PubMed  CAS  Google Scholar 

  31. Ragnarson-Tennvall G, Apelqvist J. Cost-effective management of diabetic foot ulcers. Pharmacoeconomics 1997; 12: 42–53

    Article  PubMed  CAS  Google Scholar 

  32. Deerochanawong C. A survey of lower limb amputation in diabetic patients. Diabet Med 1992; 9: 942–64

    Article  PubMed  CAS  Google Scholar 

  33. Waugh N. Amputations in diabetic patients: a review of rates, relative risks and resource use. Community Med 1989; 6: 346–50

    CAS  Google Scholar 

  34. Wood J. A review of diabetes initiatives in primary care settings. Health Trends 1990; 22: 39–43

    PubMed  CAS  Google Scholar 

  35. Buxton M, Sculpher M, Ferguson B, et al. Screening for treatable diabetic retinopathy: a comparison of different methods. Diabetic Med 1991; 8: 371–7

    Article  PubMed  CAS  Google Scholar 

  36. James M, Turner D, Broadbent D, et al. Cost-effectiveness analysis of screening for sight threatening diabetic eye disease. BMJ 2000; 320: 1627–31

    Article  PubMed  CAS  Google Scholar 

  37. Lairson D, Puigh J, Kapadia N, et al. Cost-effectiveness of alternative methods for diabetic retinopathy screening. Diabetes Care 1992; 15: 1369–77

    Article  PubMed  CAS  Google Scholar 

  38. Javitt J, Aiello L. Cost-effectiveness of detecting and treating diabetic retinopathy. Ann Intern Med 1996; 124: 164–9

    PubMed  CAS  Google Scholar 

  39. Crijns H, Casparie A, Hendrikse F. Continuous computer simulation analysis of the cost-effectiveness of screening and treating diabetic retinopathy. Int J Technol Assess Health Care 1999; 15: 198–206

    Article  PubMed  CAS  Google Scholar 

  40. Krentz A, Acheson P, Basu A, et al. Morbidity and mortality associated with diabetic foot disease: a 12 month prospective survey of hospital admissions in a single UK centre. Foot 1997; 7: 144–7

    Article  Google Scholar 

  41. Ollendorf D, Kotsanos J, Wishner W, et al. Potential economic benefits of lower extremity amputation prevention strategies in diabetes. Diabetes Care 1998; 21: 1240–5

    Article  PubMed  CAS  Google Scholar 

  42. van Houtum W, Lavery L, Harkless L. The costs of diabetes related lower extremity amputations in the Netherlands. Diabet Med 1995; 12:777–81

    Article  PubMed  Google Scholar 

  43. Panayiotopoulos Y, Tyrell M, Arnold F, et al. Results and cost analysis of distal (crural/pedal) arterial revascularisation for limb salvage in diabetic and non-diabetic patients. Diabet Med 1997; 14: 214–20

    Article  PubMed  CAS  Google Scholar 

  44. Eckman M, Greenfield S, Mackey W, et al. Foot infections in diabetic patients: decision and cost-effectiveness analysis. JAMA 1995; 273: 712–20

    Article  PubMed  CAS  Google Scholar 

  45. Herman W, Alexander C, Cook J, et al. Effect of simvastatin treatment on cardiovascular resource utilisation in impaired fasting glucose and diabetes. Diabetes Care 1999; 22: 1771–8

    Article  PubMed  CAS  Google Scholar 

  46. Grover S, Coupal L, Zowall H, et al. Cost-effectiveness of treating hyperlipidemia in the presence of diabetes: who should be treated? Circulation 2000; 102: 722–7

    Article  PubMed  CAS  Google Scholar 

  47. Grover S, Coupal L, Zowall H, et al. How cost-effective is the treatment of dyslipidemia in patients with diabetes but without cardiovascular disease. Diabetes Care 2001; 24: 45–50

    Article  PubMed  CAS  Google Scholar 

  48. Banz K, Dinkel R, Hanefeld M, et al. Evaluation of the potential clinical and economic effects of bodyweight stabilisation with acarbose in patients with type 2 diabetes mellitus. Pharmacoeconomics 1998; 13: 449–59

    Article  PubMed  CAS  Google Scholar 

  49. Rodby R, Firth L, Lewis E, et al. An economic analysis of captopril in the treatment of diabetic nephropathy. Diabetes Care 1996; 19: 1051–61

    Article  PubMed  CAS  Google Scholar 

  50. Costa B, Arroyo J, Sabate A. The economics of pharmacotherapy for diabetes mellitus. Pharmacoeconomics 1997; 11: 139–58

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This study was funded in part by a London NHS Executive grant. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Maria Raikou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Raikou, M., McGuire, A. The Economics of Screening and Treatment in Type 2 Diabetes Mellitus. Pharmacoeconomics 21, 543–564 (2003). https://doi.org/10.2165/00019053-200321080-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-200321080-00002

Keywords

Navigation