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