Clinical benefits and cost saving of achieving composite treatment targets for type 2 diabetes – A modeling study

This study assessed the long-term clinical benefits and cost savings associated with achieving composite treatment targets (CTT) of stringent glycemic control, weight reduction and no hypoglycemia in predominantly Chinese patients with Type 2 Diabetes (T2D) inadequately controlled with metformin and/or sulfonylurea. The study was conducted using an implementation of the UK Prospective Diabetes Study Outcomes Model Version 2 (UKPDS OM2) in Microsoft Excel, with additional modules for treatment switching, weight change, and hypoglycemia. Thirty-year healthcare costs were projected to capture macro- and microvascular complications, hypoglycemia and diabetic treatment. Baseline and efficacy inputs were extracted from the SURPASS-AP-Combo trial (NCT04093752), a predominantly Chinese cohort. Cost inputs were derived from literature review. Patients were categorized as “Achieved” or “Failed” based on whether they met the CTT (i.e. HbA1c ≤6.5%, ≥10% weight reduction, and no hypoglycemia event [blood glucose < 3.0 mmol/L or severe hypoglycemia]) at the end of SURPASS-AP-Combo trial, regardless of treatment received. For the Achieved group, sustained CTT was assumed for 3, 5, or 10 years before natural disease progression per UKPDS OM2 progression trajectories. The Failed group followed UKPDS OM2 progression trajectories throughout. Treatment intensification to basal-bolus insulin was triggered when HbA1c levels reached predefined CTT-based thresholds. Scenario analyses applied less stringent CTT. Sustained achievement of CTT for 3, 5 and 10 years yielded 0.31, 0.40 and 0.56 quality-adjusted life years (QALYs) and cost savings of ¥22,336, ¥32,692, ¥53,234 per patient, respectively. These savings were attributable to reduced complications, hypoglycemia and delayed treatment intensification. Slightly smaller savings were observed applying less stringent CTT. In this modeling study, a sustained achievement of CTT led to improved clinical benefits and significant direct medical cost savings. The longer the achievement period and the more stringent CTT, the greater the clinical benefits and cost savings. Type 2 diabetes (T2D) is a growing health challenge in China, where many patients struggle to manage their blood sugar and weight effectively. This study looked at the long-term health and cost benefits of achieving three treatment goals: blood sugar control, weight loss, and avoiding low blood sugar episodes. Using a UK Prospective Diabetes Study Outcomes Model Version 2 (UKPDS OM2) based on patient data from a clinical trial recruiting predominantly Chinese adults with T2D, researchers found that patients who met these goals for several years had fewer diabetes-related complications, lived longer, and had better quality of life. They also saved money on healthcare costs—up to ¥53,234 per person over 30 years. The longer patients maintained these goals, the greater the benefits. These findings support the importance of achieving and maintaining treatment targets to improve health outcomes and reduce costs for people with T2D in China.