Zusammenfassung
Principles: Different intervention strategies or the optimisation
of disease management of diabetes exist and have been shown to increase
the proportion of patients receiving screening and examinations and
to improve risk factors such as HbA1c, lipids, and blood pressure.
Thus, in the long-term, a decrease in diabetic complications and
the associated costs could be expected. To address this question,
the current analysis used a published diabetes simulation model to
analyse the long-term clinical and economic implications of implementing
various interventions in the Swiss setting.
Methods: Based on data rom the literature, the short-term effects
on clinical variables of multifactorial interventions, including
screening for nephropathy and retinopathy, educational programmes
and control of cardiovascular risk profile were assessed, and a cost-effectiveness
analysis in comparison to standard care was performed. Life expectancy
(LE) and total lifetime costs (TC) from the perspective of the health
insurance payer were calculated using a long-term Markov simulation
model.
Results: The multifactorial intervention led to an improvement in
undiscounted LE of 0.56 years (LE =10.73 and 11.29 years for standard
care and multifactorial intervention respectively), and a reduction
in 3%-discounted TC of CHF 7313 (10.7%) per patient compared to current
standard practice. Extrapolation to the whole Swiss type 2 diabetes
population (285 000) showed yearly cost savings of CHF 194 million
from the multifactorial intervention.
Conclusions: The implementation of multifactorial interventions,
including improved control of cardiovascular risk actors, combined
with early diagnosis and treatment of diabetic complications, could
be both cost- and life-saving in the Swiss setting..
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