Skip Navigation

European Heart Journal 2000 21(9):733-739; doi:10.1053/euhj.1999.1859
Copyright © 2000 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (25)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Almbrand, B
Right arrow Articles by Rydén, L
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Almbrand, B
Right arrow Articles by Rydén, L
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Cost-effectiveness of intense insulin treatment after acute myocardial infarction in patients with diabetes mellitus. Results from the DIGAMI study

B Almbranda,f1, M Johannessonb, B Sjöstrandc, K Malmberga and L Rydéna

a Department of Cardiology, Karolinska Hospital, Stockholm, Sweden
b Centre for Health Economics, Stockholm School of Economics, Stockholm, Sweden
c SBL Vaccine AB, Stockholm, Sweden

revised July 12, 1999; accepted July 22, 1999

Abstract

Aims The aim of the present analysis was to estimate the cost-effectiveness of intense insulin treatment after acute myocardial infarction in patients with diabetes mellitus based on the results of the Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. In this study 620 patients with diabetes mellitus and acute myocardial infarction were randomized to intense insulin treatment (insulin group) or to serve as controls given standard antidiabetic therapy. Mortality was significantly reduced in the insulin group.

Methods and Results The cost-effectiveness ratio was estimated as the incremental cost per life-year and quality-adjusted life-year gained of intense insulin treatment. The incremental costs were estimated as the difference in health care costs and indirect costs (labour production) during the first year of follow-up plus the future costs of increased survival. The life-years gained were based on the 5-year long-term follow-up experience and an assumed annual 20% mortality risk for all patients thereafter. The health care costs were Euro 975 higher in the insulin group during the first year of follow-up, mainly due to a longer period of initial hospitalization related to the institution of multidose insulin. The estimated discounted gain in life-years of the insulin treatment was 0·94 years without and 0·66 with quality of life adjustment, respectively. The cost per life-year gained by intense insulin treatment was Euro 16900 and the cost per quality-adjusted life-year gained was Euro 24100. Thus the estimated cost-effectiveness ratios were relatively low.

Conclusion The results of the DIGAMI study indicate that intense insulin treatment after an acute myocardial infarction in patients with diabetes mellitus has an acceptable level of cost-effectiveness.

Key Words: Myocardial infarction, diabetes mellitus, survival, cost-effectiveness, insulin

f1 Correspondence: Björn Almbrand, MD, Department of Cardiology, Karolinska Hospital, S-171 76 Stockholm, Sweden.

References

  1. Malmberg K, Rydén L. Myocardial infarction in patients with diabetes mellitus. Eur Heart J. 1988;9:256–264
  2. Stone P, Muller J, Hartwell T. The effect of diabetes mellitus on prognosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. J Am Coll Cardiol. 1989;14:49–57[Abstract]
  3. Karlson BW, Herlitz J, Hjalmarson A. Prognosis of acute myocardial infarction in diabetic and non-diabetic patients. Diabet Med. 1993;10:449–454[Web of Science][Medline]
  4. Barbash GI, White HD, Modan M, Van dWerff F. Significance of diabetes mellitus in patients with acute myocardial infarction receiving thrombolytic therapy. J Am Coll Cardiol. 1993;22:707–713[Abstract]
  5. Malmberg K, Rydén L, Efendic S. A randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol. 1995;26:57–65[Abstract]
  6. Malmberg K. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. Br Med J. 1997;314:1512–1515[Abstract/Free Full Text]
  7. Drummond MF, O'Brien B, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes, second edition. Oxford: Oxford Medical Publications; 1997.
  8. Johannesson M. Theory and methods of economic evaluation of health care. Dordrecht: Kluwer Academic Publishers; 1996.
  9. Meltzer D. Accounting for future costs in medical cost-effectiveness analysis. J Health Econ. 1997;16:33–64[CrossRef][Web of Science][Medline]
  10. Johannesson M, Meltzer D, O'Conor RM. Incorporating future costs in medical cost-effectiveness analysis: implications for the cost-effectiveness of the treatment of hypertension. Med Decis Making. 1997;17:382–389[Abstract/Free Full Text]
  11. Johannesson M, Meltzer D. Some reflections on cost-effectiveness analysis. Health Economics. 1998;7:1–7[CrossRef][Web of Science][Medline]
  12. Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russel LB. Recommendations of the Panel on Cost-Effectiveness in Health and Medicine. JAMA. 1996;276:1253–1258[Abstract/Free Full Text]
  13. Läkemedelsinformation AB. FASS 1998, Pharmaceutical specialities in Sweden. Stockholm: Läkemedelsinformation AB; 1998.
  14. Statistical yearbook of Sweden. Stockholm: Statistics Sweden; 1998.
  15. Beck JR, Kassirer JP, Pauker SG. A convenient approximation of life expectancy (the "DEALE"): I. Validation of the method. Am J Med. 1982;73:883–888[CrossRef][Web of Science][Medline]
  16. Beck JR, Kassirer JP, Pauker SG. A convenient approximation of life expectancy (the "DEALE"): II. Use in medical decision-making. Am J Med. 1982;73:889–897[CrossRef][Web of Science][Medline]
  17. Lundberg L, Johannesson M, Isacson DGL, Borgquist L. Health-state utilities in a general population in relation to age, gender, and socioeconomic factors. Eur J Public Health. 1999;9:211–217[Abstract/Free Full Text]
  18. Tsevat J, Goldman L, Soukup JR, Lamas GA, Connors KF, Chapin CC, Lee TH. Stability of time-tradeoff utilities in survivors of myocardial infarction. Med Decis Making. 1993;13:161–165[Abstract/Free Full Text]
  19. Glasziou PP, Bromwich S, Simes JR. Quality of life six months after myocardial infarction treated with thrombolytic therapy. Med J Australia. 1994;161:532–536
  20. Newbold P. Statistics for business and economics. Englewood Cliffs: Prentice-Hall; 1991.
  21. SAMPLAN, Översyn av samhällsekonomiska kalkylvärden för den nationella trafikplaneringen 1994–1998, Stockholm, SAMPLAN, 1995
  22. Laupacis A, Feeny D, Detsky AS, Tugwell PX. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can Med Assoc J. 1992;146:473–481[Abstract]
  23. Martens LL, Rutten FF, Erkelens DW, Ascoop CA. Cost-effectiveness of cholesterol-lowering therapy in the Netherlands. Am J Med. 1989;87:54S–58S[CrossRef][Medline]
  24. Tosteson AN, Rosenthal DI, Melton LJ, Weinstein MC. Cost-effectiveness of screening perimenopausal white women for osteoporosis: bone densitometry and hormone replacement therapy. Ann Int Med. 1990;113:594–603[Abstract/Free Full Text]
  25. Goldman L, Weinstein MC, Goldman PA, Williams LW. Cost-effectiveness of HMG-CoA reductase inhibition for primary and secondary prevention of coronary heart disease. JAMA. 1991;265:1145–1151[Abstract/Free Full Text]
  26. van Hout B, Bonsel G, Habbema D, Vandermaas P, Decharro F. Heart transplantation in the Netherlands: costs, effects and scenarios. J Health Econ. 1993;12:73–93[CrossRef][Web of Science][Medline]
  27. Johannesson M, Borgquist L, Jönsson B, Lindholm LH. The cost effectiveness of lipid lowering in Swedish primary health care. J Intern Med. 1996;240:23–29[CrossRef][Web of Science][Medline]
  28. Johannesson M, Jönsson B, Kjekshus J, Olsson AG, Pedersen TR, Wedel H. Cost-effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease. N Engl J Med. 1997;336:332–336[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Diabetes CareHome page
A. R. Sadhu, A. C. Ang, L. A. Ingram-Drake, D. S. Martinez, W. A. Hsueh, and S. L. Ettner
Economic Benefits of Intensive Insulin Therapy in Critically Ill Patients: The Targeted Insulin Therapy to Improve Hospital Outcomes (TRIUMPH) Project
Diabetes Care, August 1, 2008; 31(8): 1556 - 1561.
[Abstract] [Full Text] [PDF]

Home page
 Ann Rheum DisHome page
G Kobelt, P Lindgren, A Singh, and L Klareskog
Cost effectiveness of etanercept (Enbrel) in combination with methotrexate in the treatment of active rheumatoid arthritis based on the TEMPO trial
Ann Rheum Dis, August 1, 2005; 64(8): 1174 - 1179.
[Abstract] [Full Text] [PDF]

Home page
 British Journal of Diabetes & Vascular DiseaseHome page
H. N Buch, D. M Barton, G. I Varughese, E. Hodgson, and J. H. Scarpello
A one-year retrospective audit of the DIGAMI protocol
The British Journal of Diabetes & Vascular Disease, November 1, 2004; 4(6): 396 - 399.
[Abstract] [PDF]

Home page
 Ann Rheum DisHome page
G Kobelt, K Eberhardt, and P Geborek
TNF inhibitors in the treatment of rheumatoid arthritis in clinical practice: costs and outcomes in a follow up study of patients with RA treated with etanercept or infliximab in southern Sweden
Ann Rheum Dis, January 1, 2004; 63(1): 4 - 10.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
M. Bartnik, K. Malmberg, and L. Ryden
Diabetes and the heart: compromised myocardial function -- a common challenge
Eur. Heart J. Suppl., January 1, 2003; 5(suppl_B): B33 - B41.
[Abstract] [PDF]

Home page
 J Am Coll CardiolHome page
H. M. Krumholz, W. S. Weintraub, W. D. Bradford, P. A. Heidenreich, D. B. Mark, and A. D. Paltiel
Task Force #2--the cost of prevention: can we afford it? Can we afford not to do it?
J. Am. Coll. Cardiol., August 21, 2002; 40(4): 603 - 615.
[Full Text] [PDF]

Home page
 Diabetes CareHome page
S. H. Roman and M. R. Chassin
Windows of Opportunity to Improve Diabetes Care When Patients With Diabetes Are Hospitalized for Other Conditions
Diabetes Care, August 1, 2001; 24(8): 1371 - 1376.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
P. Hildebrandt
Intensive insulin treatment of diabetic patients with myocardial infarction is highly cost-effective
Eur. Heart J., May 1, 2000; 21(9): 700 - 702.
[PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (25)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Almbrand, B
Right arrow Articles by Rydén, L
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Almbrand, B
Right arrow Articles by Rydén, L
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?