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Table 1—

Cost-effectiveness of blood pressure–and lipid-lowering treatment in patients with diabetes

Tight blood pressure control
Lipid control
MaleFemaleBothMaleFemaleBoth
Net cost (r = 5%)* −606 −888 −747 3,590 3,980 3,780 
Life expectancy 14.5 16.9 15.7 14.5 16.9 15.7 
Years of life gained 0.78 (0.18–1.46) 0.99 (0.34–1.70) 0.88 (0.26–1.58) 0.78 (0.62–0.95) 0.89 (0.70–1.07) 0.84 (0.66–1.01) 
Cost/life-year gained (r = 5%)§ −1,690 (−19,200 to 16,300) −2,080 (−18,800 to 14,100) −1,910 (−18,900 to 15,100) 9,940 (−2,000 to 22,900) 10,200 (−2,610 to 24,800) 10,100 (−2,540 to 23,600) 
Cost/QALY (r = 0%) −1,620 −1,750 −1,690 5,660 5,550 5,600 
Cost/QALY (r = 3%) −1,490 −1,630 −1,570 7,200 7,040 7,110 
Cost/QALY (r = 5%) −1,260 (−13,400 to 10,000) −1,520 (−13,400 to 8,200) −1,400 (−13,400 to 8,590) 8,380 (−1,720 to 18,800) 8,100 (−2,520 to 18,900) 8,230 (−2,280 to 18,900) 
Tight blood pressure control
Lipid control
MaleFemaleBothMaleFemaleBoth
Net cost (r = 5%)* −606 −888 −747 3,590 3,980 3,780 
Life expectancy 14.5 16.9 15.7 14.5 16.9 15.7 
Years of life gained 0.78 (0.18–1.46) 0.99 (0.34–1.70) 0.88 (0.26–1.58) 0.78 (0.62–0.95) 0.89 (0.70–1.07) 0.84 (0.66–1.01) 
Cost/life-year gained (r = 5%)§ −1,690 (−19,200 to 16,300) −2,080 (−18,800 to 14,100) −1,910 (−18,900 to 15,100) 9,940 (−2,000 to 22,900) 10,200 (−2,610 to 24,800) 10,100 (−2,540 to 23,600) 
Cost/QALY (r = 0%) −1,620 −1,750 −1,690 5,660 5,550 5,600 
Cost/QALY (r = 3%) −1,490 −1,630 −1,570 7,200 7,040 7,110 
Cost/QALY (r = 5%) −1,260 (−13,400 to 10,000) −1,520 (−13,400 to 8,200) −1,400 (−13,400 to 8,590) 8,380 (−1,720 to 18,800) 8,100 (−2,520 to 18,900) 8,230 (−2,280 to 18,900) 
*

Costs shown are in U.S. dollars (originally in U.K. pounds sterling and 2003 prices and converted using U.K. £0.65 = $1 U.S.). The cost of additional hypertensive therapy was estimated to be $154/year and, for statin therapy, $571/year. The cost of drug treatment was assumed to continue until death. Other costs included acute and chronic management after MI and stroke. Future costs were discounted at 5% per annum. Costs are shown to three significant figures.

Model prediction of life expectancy for untreated patients from age 60 years. This compares with population average estimates for men and women of 19 and 23 years. Subjects modeled have diabetes and are nonsmokers of 60 years of age with total cholesterol (TDL)/LDL 5.8/1.3 mmol/l, BP 160/80 mmHg. Of the subjects, 14% were modeled as having left ventricular hypertrophy (LVH) as a proxy for existing cardiovascular disease.

Model prediction of life-years (LY) gained and 95% CI shown in parentheses. Modeling details are found in research design and methods.

§

Cost per life-year gained and 95% CI shown in parentheses; future costs and benefits discounted at 5% per annum. Cost-effectiveness ratios are shown to three significant figures.

Cost per QALY gained and 95% CI shown in parentheses; future costs and benefits discounted at 0, 3, and 5% per annum. Cost-effectiveness ratios are shown to three significant figures.

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