American Diabetes Association (ADA) guideline on glycemic control recommends an A1c <7% in most adults with diabetes and 7-8% for those with history of hypoglycemia, limited life expectancy, or comorbid conditions. From 2013-2016, 64% of U.S. adults with diabetes met ADA A1c goals. Using data from the ACCORD trial, we estimated the cost of achieving the two A1c goals, defined as reaching the goal for two consecutive follow-up visits. Costs of the diabetes drugs were estimated from Marketscan data. Costs by baseline A1c levels were estimated using a generalized linear model with Gamma distribution and log link. 3698 participants in the control arm achieved the goal of 7-7.9%, and 4135 in the intervention arm achieved the goal of <7%. Estimated monthly cost increased by baseline A1c level and was higher for achieving A1c<7% than 7-7.9% (Figure). In patients with a baseline A1c of 11%, the estimated cost was $610 per month ($7320 per year) for achieving <7% and $413 per month ($4956 per year) for achieving 7-7.9%. In patients with a baseline A1c level of 9%, the corresponding estimates were $430 per month ($5160 per year) and $266 per month ($3192 per year). Our study provides critical cost estimates needed for assessing the cost-effectiveness of tighter glucose control in the U.S.
P. Zhang: None. H. Shao: None. A. Bertoni: None. L. Lovato: None. H. Chen: None.