Cost-effectiveness of lower targets for blood pressure and low-density lipoprotein cholesterol in diabetes: The Stop Atherosclerosis in Native Diabetics Study (SANDS)

Wilson, Charlton; Huang, Chun-Chih; Shara, Nawar; Howard, Barbara V.; Fleg, Jerome L.; Henderson, Jeffrey A.; Howard, Wm. James; Huentelman, Heather; Lee, Elisa T.; Mete, Mihriye; Russell, Marie; Galloway, James M.; Silverman, Angela; Stylianou, Mario; Umans, Jason; Weir, Matthew R.; Yeh, Fawn; Ratner, Robert E.

doi:10.1016/j.jacl.2010.01.008

« Previous Next »Journal of Clinical Lipidology
Volume 4, Issue 3 , Pages 165-172, May 2010

Cost-effectiveness of lower targets for blood pressure and low-density lipoprotein cholesterol in diabetes: The Stop Atherosclerosis in Native Diabetics Study (SANDS)

Charlton Wilson, MD
- Phoenix Indian Medical Center, 4212 N 16^th Street, Phoenix, AZ, 85016, USA
- Corresponding author.
Chun-Chih Huang, PhD
- MedStar Research Institute, Hyattsville, MD, USA
Nawar Shara, PhD
- MedStar Research Institute, Hyattsville, MD, USA
Barbara V. Howard, PhD
- MedStar Research Institute, Hyattsville, MD, USA
Jerome L. Fleg, MD
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
Jeffrey A. Henderson, MD, MPH
- Black Hills Center for American Indian Health, Rapid City, SD, USA
Wm. James Howard, MD
- Washington Hospital Center, Washington, DC, USA
Heather Huentelman, PharmD
- Phoenix Indian Medical Center, 4212 N 16^th Street, Phoenix, AZ, 85016, USA
Elisa T. Lee, PhD
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
Mihriye Mete, PhD
- MedStar Research Institute, Hyattsville, MD, USA
Marie Russell, MD
- Phoenix Indian Medical Center, 4212 N 16^th Street, Phoenix, AZ, 85016, USA
James M. Galloway, MD
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Angela Silverman, MSN, CANP
- MedStar Research Institute, Hyattsville, MD, USA
Mario Stylianou, PhD
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
Jason Umans, MD, PhD
- MedStar Research Institute, Hyattsville, MD, USA
Matthew R. Weir, MD
- University of Maryland School of Medicine, Baltimore, MD, USA
Fawn Yeh, PhD
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Robert E. Ratner, MD
- MedStar Research Institute, Hyattsville, MD, USA

Received 27 January 2010; accepted 29 January 2010. published online 08 February 2010.

Background

The Stop Atherosclerosis in Native Diabetics Study (SANDS) reported cardiovascular benefit of aggressive versus standard treatment targets for both low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) in diabetic individuals.

Objective

In this analysis, we examined within trial cost-effectiveness of aggressive targets of LDL-C ≤70 mg/dL and systolic BP ≤115 mmHg versus standard targets of LDL-C ≤100 mg/dL and systolic BP ≤130 mmHg.

Design

Randomized, open label blinded-to-endpoint 3-year trial.

Data Sources

SANDS clinical trial database, Quality of Wellbeing survey, Centers for Medicare and Medicaid Services, Wholesale Drug Prices.

Target Population

American Indians ≥age 40 years with type 2 diabetes and no previous cardiovascular events.

Time Horizon

April 2003 to July 2007.

Perspective

Health payer.

Interventions

Participants were randomized to aggressive versus standard groups with treatment algorithms defined for both.

Outcome Measures

Incremental cost-effectiveness.

Results of Base-Case Analysis

Compared with the standard group, the aggressive group had slightly lower costs of medical services (−$116) but a 54% greater cost for BP medication ($1,242) and a 116% greater cost for lipid-lowering medication ($2,863), resulting in an increased cost of $3,988 over 3 years. Those in the aggressively treated group gained 0.0480 quality-adjusted life-years (QALY) over the standard group. When a 3% discount rate for costs and outcomes was used, the resulting cost per QALY was $82,589.

Results of Sensitivity Analysis

The use of a 25%, 50%, and 75% reduction in drug costs resulted in a cost per QALY of $61,329, $40,070, and $18,810, respectively.

Limitations

This study was limited by use of a single ethnic group and by its 3-year duration.

Conclusions

Within this 3-year study, treatment to lower BP and LDL-C below standard targets was not cost-effective because of the cost of the additional medications required to meet the lower targets. With the anticipated availability of generic versions of the BP and lipid-lowering drugs used in SANDS, the cost-effectiveness of this intervention should improve.

Keywords: Cost effectiveness, Diabetes mellitus, Lipids, Blood pressure, Quality of well being, Clinical trial