Comparative effectiveness and cost-effectiveness of treat-to-target versus benefit-based tailored treatment of type 2 diabetes in low-income and middle-income countries: a modelling analysis

Publication date: Available online 4 October 2016 Source:The Lancet Diabetes & Endocrinology Author(s): Sanjay Basu, Vishnu Shankar, John S Yudkin Background Optimal prescription of blood pressure, lipid, and glycaemic control treatments for adults with type 2 diabetes remains unclear. We aimed to compare the effectiveness and cost-effectiveness of two treatment approaches for diabetes management in five low-income and middle-income countries. Methods We developed a microsimulation model to compare a treat-to-target (TTT) strategy, aiming to achieve target levels of biomarkers (blood pressure <130/80 mm Hg, LDL <2·59 mmol/L, and HbA1c <7% [ie, 53·0 mmol/mol]), with a benefit-based tailored treatment (BTT) strategy, aiming to lower estimated risk for complications (to a 10 year cardiovascular risk <10% and lifetime microvascular risk <5%) on the basis of age, sex, and biomarker values. Data were obtained from cohorts in China, Ghana, India, Mexico, and South Africa to span a spectrum of risk profiles. Findings The TTT strategy recommended treatment to a larger number of people—who were generally at lower risk of diabetes complications—than the BTT. The BTT strategy recommended treatment to fewer people at higher risk. Compared with the TTT strategy, the BTT strategy would be expected to avert 24·4–30·5% more complications and be more cost-effective from a societal perspective (saving US$4·0–300·0 per disability-ad...
Source: The Lancet Diabetes and Endocrinology - Category: Endocrinology Source Type: research