OBJECTIVES:

Understanding the relationship between improved glucose control and modeled gains in life-expectancy (LE) and quality-adjusted-life-expectancy (QALE) in type-2-diabetes (T2D) populations is important for health policy decision making. A recently published systematic review assessed this relationship based on 76 modeled cost-effectiveness-studies in T2D. The review quantified the relationship between changes in glucose control and gains in LE and QALE, with limited commentary on why some modeling studies project relatively higher gains of LE vs. QALE. The objective of our study was to use a T2D simulation model for a series of heterogeneous T2D-populations to identify factors associated with reduced QALE vs. LE benefit.

METHODS:

We used version 9.0 of the QuintilesIMS-CORE-diabetes-model (QI-CDM) to project the lifetime benefits (gains in LE and QALE) of a 1%-point HbA1c reduction. Patient characteristics were obtained from NHANES patient-level-data and stratified to three age categories: Young (30-yrs), intermediate-aged (50-yrs), elderly (70-yrs). Each age category was further sub-divided into five levels of increasing degree of baseline comorbidity from level-0 (no comorbidities) to level-4 (high comorbidity level). Outcomes were discounted at 3%.

RESULTS:

For patients with no baseline comorbidities, the respective gains in LE and QALE associated with a 1%-point A1c lowering were 0.48 and 0.58, 0.68 and 0.64 and 0.35 and 0.34 for young, intermediate-aged and elderly, respectively. The corresponding ratio of QALE vs. LE gain (QALE/LE-ratio) was 120%, 93.2% and 95.5%. For increasing comorbidity levels, the QALE/LE-ratio declined to levels of 120.8%, 111%, 110% and 74% (young), 88.7%, 81.5%, 71.9% and 60.3% (intermediate aged) and 84.9%, 78.5%, 69.7% and 60.0% (elderly) for comorbidity levels 1 to 4, respectively.

CONCLUSIONS: