MUNICH — Treating patients with impaired glucose tolerance who also have a high risk of cardiovascular disease with acarbose is cost-effective when balanced against the savings in terms of cases of type 2 diabetes and its cardiovascular complications avoided, Thomas Evers, M.D., said at the annual congress of the European Society of Cardiology.
His cost-benefit analysis, based on data from the Study to Prevent Non-Insulin-Dependent Diabetes Mellitus (STOP-NIDDM), concluded that it cost 772 euros in medication costs and physician office visits under the German fee scale to prevent a single case of diabetes over a 3.3-year period.
STOP-NIDDM was an international randomized trial in which 1,368 patients with impaired glucose tolerance were randomized to acarbose—an alpha-glucosidase inhibitor that delays glucose absorption—or placebo. The trial showed that acarbose resulted in a significant delay in development of type 2 diabetes (Lancet 2002;359:2072-7) and reduced incidences of cardiovascular events and hypertension (JAMA 2003;290:486-94).
In a subgroup analysis restricted to the one-quarter of STOP-NIDDM participants at highest cardiovascular risk according to Framingham risk score, prescribing acarbose routinely in such a population would actually save a health care system money.
That is to say, juxtaposing the cost of acarbose therapy and the related physician office visits against the estimated cost of caring for the additional events—diabetes, acute MI, stroke, angina, heart failure, hypertension, and peripheral artery disease—occurring in the placebo group, prescribing acarbose in patients in the high-risk subgroup saved 674 euros per patient, according to Dr. Evers of Bayer Vital GmbH in Leverkusen, Germany, the manufacturer of acarbose.