OBJECTIVES: To estimate the potential benefits in terms of complications avoided and cost reduction if the Spanish health system encouraged switching patient treatment to better glycaemic control for adults with Type 2 diabetes at the target HbA1c of 53 mmol/mol (7%) instead of current practice which on average escalates treatment at 68 mmol/mol (8.4%).

METHODS: The IQVIA Core Diabetes Model was used to model the impact of these changes in respect of micro- and macrovascular complications and the associated costs. Management and complication costs were adapted to Spain in the model which which translates surrogate endpoints into long-term health and economic outcomes. The modelling was based on patient data derived from the SIDIAP-Q population database from Catalonia, taking a random cohort of 10,000 diabetes type 2 patients and dividing it into sub-groups based on their reported HbA1c level. Cumulative incidence of complications over a 25 year period was calculated for the base and comparator cases. Results were extrapolated for the type 2 diabetes population in Spain.

RESULTS: The modelling showed that the average cost reduction per person varies depending on basal HbA1c. After 25 years, people with basal HbA1c between 48 and 58 mmol/mol and >75 mmol/mol show an average cost reduction of €6,027 and €11,966, respectively. Applying the per-person cost reduction to the cohorts of the prevalent population in Spain (1,910,374) the overall estimated cost reduction was €14.7 billion over 25 years. The improvements in outcomes resulted in an estimated reduction of more than 1.2 million complications cumulatively over 25 years, of which more than 550,000 relate to diabetic foot and neuropathy.

CONCLUSIONS: There is scope for considerable cost reductions and avoidance of major complications if, on a population level, better glycaemic control can be achieved among people with type 2 diabetes in Spain by reducing the threshold of HbA1c for treatment intensification.