The increased spending on healthcare for Type 2 diabetes in recent years appears to be of value in terms of the adverse outcomes prevented, according to a study published in the Annals of Internal Medicine.

Joseph Newhouse (Harvard Medical School, Boston, Massachusetts, USA) and colleagues explain that chronic diseases account for a large share of total healthcare spending, but it is uncertain whether increases in spending always buy better outcomes for patients.

To address this issue, the researchers performed an economic analysis using data from an observational cohort of 613 Mayo Clinic patients with Type 2 diabetes to determine the net value of healthcare for this population.

The authors assessed changes in inflation-adjusted annual healthcare spending and in health status between 1997 and 2005. Two approaches were used to determine change in health status: 10-year risk for nonfatal and fatal coronary heart disease, and changes in each patient’s predicted remaining life expectancy and quality-adjusted life-years (QALY).

Spending data were obtained for all medical care, whether or not related to patients’ diagnosis of diabetes.

The authors defined net value as the present discounted monetary value of improved survival and avoided treatment spending for coronary heart disease minus the increase in annual spending per patient.

During the study period, control of coronary risk factors such as glycated hemoglobin, blood pressure, and serum lipids, improved with a consequent decrease in modifiable 10-year risk estimates.

Overall, there was a mean increase in predicted life expectancy and QALYs based on all diabetes-related complications of 0.123 years and 0.087 years, respectively.

Total spending during the study period more than doubled, with the greatest increases for inpatient services and pharmacy costs (142% for both).

Assuming that 1 life-year is worth $200,000 (€136,444) and accounting for changes in modifiable cardiovascular risk, the authors estimated the net value of changes in healthcare for patients with Type 2 diabetes as $10,911 (€7,444) per patient between 1997 and 2005.

“A positive dollar value that suggests the value of healthcare has improved despite increased spending,” explain the authors. Estimates remained positive when values of $100,000 (€68,222) and $300,000 (€204,666) were used.

A second approach based on diabetes complications yielded a net value of $6931 (€4,728) per patient.

“We estimate that the value of improved survival from lower cardiovascular risks exceeds or approximates the increased spending on care,” write the authors, although they caution that the estimates are based on a small group of patients and on many assumptions.

In their conclusions, they acknowledge that it is unlikely that the current spending increases can be sustained. “It is still necessary to enhance value for money spent on care for patients with chronic conditions such as diabetes,” they write.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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