The economic burden of poor glycemic control associated with therapeutic inertia in patients with type 2 diabetes in Denmark

Abstract

Objective

To evaluate the economic burden associated with therapeutic inertia in patients with type 2 diabetes mellitus (T2D) in Denmark.

Methods

The economic burden for a newly diagnosed Danish T2D population was estimated using a validated diabetes model (The Swedish Institute for Health Economics (IHE) Cohort model), based on achieving varying levels of glycemic control. The analyses were based on clinical data from the Danish Centre for Strategic Research (DD2) and supplemented with relevant Swedish data where variables were missing. The analysis estimated the economic burden for populations achieving different guideline-recommended targets for glycated hemoglobin (HbA_1c) and for a number of therapeutic inertia scenarios. To estimate the population-level burden Danish specific epidemiology data were incorporated. All costs are reported in 2020 Danish kroner (DKK) and 2020 Euros (€).

Results

The baseline HbA_1c level used for this analysis was 7.9% (63 mmol/mol), which was observed in newly diagnosed Danish T2D patients prior to their first anti-diabetic treatment. Therapeutic inertia was associated with substantial economic burden compared to achieving immediate glycemic control (target < 6.5% (< 48 mmol/mol)). Per patient burdens were between 3562 DKK and 20,160 DKK (€477– €2701) dependent on the duration of therapeutic inertia (1−7 years), with this further increased when indirect costs were included (9649 DKK to 51,585 DKK [€1393–€6912]). The economic burden at a population level was between 27 million DKK to 150 million DKK (€3.6 million to €20 million), dependent on the duration of therapeutic inertia, rising to 72 million DKK to 384 million DKK (€9.6 million to €51.4 million) when indirect costs were included.

Conclusion

Achieving early and intensive glycemic control, thereby minimizing therapeutic inertia can lead to substantial savings for the Danish society, ranging between 72 million DKK and 384 million DKK (€9.6 million to €51.4 million) (1−7 years of therapeutic inertia). This study highlights that efforts to minimize therapeutic inertia, by securing timely intensification before individual HbA_1c targets are exceeded, results in significant long-term cost savings in Denmark.

Keywords:

• Diabetes mellitus
• type 2
• Cost of illness
• health care cost
• guideline
• health economic modelling
• poor control
• complications

Transparency

Declaration of funding

The manuscript was funded by Novo Nordisk.

Declaration of financial/other relationships

AL, MPT and RK are employees of NHTA, Denmark. CKT is an employee of Novo Nordisk Denmark A/S. PG is employed by Institute for Regional Health Research, University of Southern Denmark, and Department of Cardiology and Endocrinology, Slagelse Hospital, Denmark. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have received an honorarium from CMRO for their review work but have no other relevant financial relationships to disclose.

Author contributions

AL and MPT contributed to study design, data collection, data analysis, data interpretation and writing the manuscript. RK contributed to data interpretation and writing the manuscript. CKT contributed to study design, data collection, data interpretation, and revising the manuscript. PG was involved in study design, data interpretation, and editorial support. All authors read the final version of the manuscript critically and approved the submitted version.

Acknowledgements

None stated.