Timely Initiation of Insulin Treatment Delays the Development of Diabetes-Related Complications Resulting in Cost Savings at a Population Level

OBJECTIVES: Many patients with type 2 diabetes (T2D) in the United Kingdom (UK) fail to achieve glycemic targets (glycated hemoglobin [HbA_1c] <7.0%) due to delays in initiating or intensifying insulin therapy, resulting in an increased risk of developing severe long-term complications (with associated costs of approximately £8 billion per year). The analysis aimed to estimate the cost savings associated with avoided complications from the timely initiation or intensification of insulin therapy for insulin-naïve people with T2D and uncontrolled hyperglycemia in the UK, compared with delayed insulin initiation or intensification.

METHODS: The analysis was conducted from the UK National Health Service perspective using the validated PRIME T2D Model. ONWARDS 5 clinical trial data informed simulated patient characteristics at baseline. From a baseline HbA_1c of 9.0%, immediate glycemic control (an HbA_1c target of 7.0%) was compared with a 7-year delay in achieving control over a 20-year time horizon. The analysis focused on the cost of managing complications arising from poor glycemic control and did not include any diabetes treatment-related costs. Outcomes of interest included the cumulative incidence of complications and the associated additional direct costs. Costs were accounted in 2022 pounds sterling (£).

RESULTS: For the simulated population of patients in the UK with T2D and poor glycemic control (N=1,552,498), timely insulin initiation or intensification would result in 150,974 fewer cumulative complications and associated cost savings of £155,672,008, compared with a delay of 7 years (£1,884,662,684 versus £2,040,334,691, respectively). The primary cost drivers were the increased incidence of severe long-term complications associated with poor glycemic control, including myocardial infarction (£60,514,610), congestive heart failure (£31,565,273), neuropathy (£31,027,965), and stroke (£21,528,650).

CONCLUSIONS: Timely insulin initiation or intensification for insulin-naïve people with T2D with poor glycemic control delays the development of diabetes-related complications and results in considerable cost savings at a population level.