Tight and early HbA1c control of type 2 diabetes mellitus in Spain: quantifying the social value

Paulina Maravilla-Herrera ¹ María Merino ^1* Sara Artola ^2,3 Javier Escalada ^4,5 Antonio Pérez Pérez ^6,7,8 Juantxo Remón ⁹ Jose Luis Trillo- Mata ¹⁰ Joan A Vallès-Callol ¹¹ Álvaro Hidalgo-Vega ^12,13

• ¹ Weber, Madrid, Spain
• ² José Marvá Health Centre, Madrid, Spain
• ³ Red de Grupos de Estudio en Atención Primaria de Salud (redGDPS) Foundation, Madrid, Spain
• ⁴ Department of Endocrinology and Nutrition, University Clinic of Navarra, Pamplona, Navarre, Spain
• ⁵ CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Madrid, Madrid, Spain
• ⁶ Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Balearic Islands, Spain
• ⁷ Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas – CIBERDEM, Madrid, Spain
• ⁸ Autonomous University of Barcelona, Barcelona, Catalonia, Spain
• ⁹ Federación Española de Diabetes, Madrid, Spain
• ¹⁰ Pharmacy service of health area Malvarrosa Clinical Department, Conselleria de Sanitat, Valencia, Spain
• ¹¹ Catalan Health Institute (ICS), Barcelona, Catalonia, Spain
• ¹² University of Castilla-La Mancha, Department of Economic Analysis and Finances, Toledo, Spain
• ¹³ Fundación Weber, Madrid, Asturias, Spain

Introduction. The aim of this study was to estimate the social value of a tight and early control of patients with type 2 diabetes during the 5 years after diagnosis in Spain, compared to higher hemoglobin A1c (HbA1c) goals. Methods. An economic model based on scientific literature was applied to estimate the 5-year social value of maintaining a tight and early type 2 diabetes control, i.e., HbA1c <6.5%, during the 5 years after diagnosis in Spain, compared with a non-tight control. Areas of analysis included healthcare resource utilization, presence of complications, quality of life, and mortality. Outcomes corresponding to these two types of control (tight vs. non-tight) were multiplied by their unit cost or financial proxy to obtain the economic impact associated to each type of control. Social value was estimated as the reduction of the economic impact of a non-tight control when a tight control is implemented and maintained. Results are expressed in 2021 euros. Results. The economic impact of a tight control during the first 5 years after type 2 diabetes diagnosis was estimated at €1,010 million in Spain (€13,473 per patient), lower than the impact of a non-tight control, which was estimated at €1,127 million (€16,122 per patient) during the same period. Conclusions. Maintaining tight and early control of type 2 diabetes during the first 5 years after diagnosis could generate a positive social value of €2,649 per patient over that period, in terms of better health outcomes, increased quality of life, and decreased premature deaths.