1040-P: The Value of the Guideline-Recommended Management of Type 2 Diabetes-A Novel Population-Level System Dynamics Approach

Introduction and Objectives: Current clinical guidelines advocate a holistic approach (HA) to type 2 diabetes (T2D) management based on glucose control, cardiovascular (CV) risk, chronic kidney disease (CKD) progression and body weight. Conventional approaches to quantifying value are likely to underestimate the benefit of treating diabetes in line with guideline recommendations due to the narrow focus of traditional health economic evaluations. With the prevalence of T2D projected to rise, we quantified the value of adopting a HA strategy across the health care system compared with a traditional glucose management (GM) strategy, from a multi-stakeholder perspective. Methods: We developed a population-level T2D system dynamics model calibrated to UK incidence and prevalence data. T2D outcomes were predicted to 2040, using rates from UKPDS. The cardiorenal benefits of HA were incorporated using odds ratios from meta-analysis of contemporary CV outcomes trials. The impact of population growth, an ageing population, and the adoption of a HA versus GM strategy on healthcare resource use, patient outcomes, societal productivity, environment, and total costs were assessed. Results: Modelled UK prevalence of diagnosed T2D in adults is expected to increase from 3.4M to 4.0M between 2023 and 2040; a GM strategy estimates an 18.6% and 17.5% increase in CV and microvascular (MV) complications, respectively, with 46.16 CV events and 4.88 MV events annually per 1,000 patients, by 2040. Applying a HA strategy to eligible patients reduced this to 42.11 CV events and 4.86 MV events annually per 1,000 patients, resulting in a reduction in direct healthcare costs of £1.68B, 171,225 fewer hospitalizations and 1.32M bed days saved, a reduction in lost income of £266.20M and a gain of 2.18M workdays. Conclusion: The cardiorenal protection offered by new T2D therapies has the potential to confer benefits to multiple stakeholders across the healthcare system.