Potential Value of Identifying Type 2 Diabetes Subgroups for Guiding Intensive Treatment: A Comparison of Novel Data-Driven Clustering to Risk-driven Subgroups
Abstract
OBJECTIVE To estimate the impact on lifetime health and economic outcomes of different methods of stratifying individuals with type 2 diabetes, followed by guideline-based treatment intensification, targeting BMI and LDL in addition to HbA1c. RESEARCH DESIGN AND METHODS We divided 2,935 newly diagnosed individuals from the Hoorn Diabetes Care System (DCS) cohort into five RHAPSODY data-driven clustering subgroups (based on age, BMI, HbA1c, C-peptide and HDL) and four risk-driven subgroups using fixed cut-offs for HbA1c and risk of cardiovascular disease based on guidelines. The UKPDS Outcomes Model 2 estimated discounted expected lifetime complication costs and quality-adjusted life-years (QALYs) for each subgroup and across all individuals. Gains from treatment intensification were compared to “care-as-usual” as observed in DCS. A sensitivity analysis was conducted based on Ahlqvist’s subgroups. RESULTS Under care-as-usual, prognosis in the RHAPSODY data-driven subgroups ranged from 7.9 to 12.6 QALYs. Prognosis in the risk-driven subgroups ranged from 6.8 to 12.0 QALYs. Compared to homogenous type 2 diabetes, treatment for individuals in high-risk subgroups could cost 22.0% and 25.3% more and still be cost-effective for data-driven and risk-driven subgroups respectively. Targeting BMI and LDL in addition to HbA1c might deliver up to ten-fold increases in QALYs gained. CONCLUSIONS Risk-driven subgroups better discriminated regarding prognosis. Both stratification methods supported stratified treatment intensification, with the risk-driven subgroups being somewhat better in identifying individuals with the most potential to benefit from intensive treatment. Irrespective of stratification approach, better cholesterol and weight control showed substantial potential for health gains.
Authors 10
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Xinyu Li corresponding
Affiliation as printed
Faculty of Science and Engineering , Groningen Research Institute of Pharmacy , University of Groningen , Groningen , the Netherlands
Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
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National Institute for Public Health and the Environment
Affiliation as printed
National Institute of Public Health and the Environment , Bilthoven , the Netherlands
National Institute of Public Health and the Environment, Bilthoven, the Netherlands
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Affiliation as printed
Health Economics Research Centre , Nuffield Department of Population Health , University of Oxford , U.K
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, U.K
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Leiden University Medical Center · Amsterdam Public Health · Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam Cardiovascular Sciences, Amsterdam Public Health, Amsterdam, the Netherlands
Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
Department of Epidemiology and Data Sciences, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam, the Netherlands
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Utrecht University · University Medical Center Utrecht · Amsterdam Public Health · Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam Cardiovascular Sciences, Amsterdam Public Health, Amsterdam, the Netherlands
Department of Epidemiology and Data Sciences, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam, the Netherlands
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Leen M. ‘t Hart Aachen Department of Biomedical Data Sciences Section Molecular Epidemiology Department of Cell and Chemical Biology
Leiden University Medical Center · Amsterdam Public Health · Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam Cardiovascular Sciences, Amsterdam Public Health, Amsterdam, the Netherlands
Department of Biomedical Data Sciences, Section Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
Department of Epidemiology and Data Sciences, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam, the Netherlands
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University of Dundee · Ninewells Hospital
Affiliation as printed
Division of Population Health and Genomics , Ninewells Hospital and School of Medicine , University of Dundee , Dundee , U.K
Division of Population Health and Genomics, Ninewells Hospital and School of Medicine, University of Dundee, Dundee, U.K
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Amsterdam Public Health · Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam Cardiovascular Sciences , Amsterdam Public Health , Amsterdam , the Netherlands
Department of General Practice , Amsterdam University Medical Center , Vrije Universiteit , Amsterdam , the Netherlands
Amsterdam Cardiovascular Sciences, Amsterdam Public Health, Amsterdam, the Netherlands
Department of General Practice, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands
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University of Groningen · National Institute for Public Health and the Environment
Affiliation as printed
Faculty of Science and Engineering , Groningen Research Institute of Pharmacy , University of Groningen , Groningen , the Netherlands
National Institute of Public Health and the Environment , Bilthoven , the Netherlands
Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
National Institute of Public Health and the Environment, Bilthoven, the Netherlands
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Affiliation as printed
Health Economics Research Centre , Nuffield Department of Population Health , University of Oxford , U.K
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, U.K
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