BACKGROUND: This article presents cost-effectiveness analyses of the major
diabetes interventions as formulated in the revised Dutch guidelines for
diabetes type 2 patients in primary and secondary care. The analyses
consider two types of care: diabetes control and the treatment of
complications, each at current care level and according to the guidelines.
METHODS: A validated probabilistic diabetes model describes diabetes and
its complications over a lifetime in the Dutch population, computing
quality-adjusted life years and medical costs. Effectiveness data and
costs of diabetes interventions are from observational current care
studies and intensive care experiments. Lifetime consequences of in total
sixteen intervention mixes are compared with a baseline glycaemic control
of 10% HBA1C. RESULTS: The interventions may reduce the cumulative
incidence of blindness, lower-extremity amputation, and end-stage renal
disease by >70% in primary care and >60% in secondary care. All primary
care guidelines together add 0.8 quality-adjusted life years per lifetime.
CONCLUSION: In case of few resources, treating complications according to
guidelines yields the most health benefits. Current care of diabetes
complications is inefficient. If there are sufficient resources, countries
may implement all guidelines, also on diabetes control, and improve
efficiency in diabetes care
