Analysis of direct cost of standard compared with intensive insulin treatment of insulin-dependent diabetes mellitus and cost of complications.

Insulin-dependent diabetes mellitus (type 1) is accompanied by long-term complications: retinopathy, nephropathy, neuropathy, as well as macrovascular complications. We compared the direct cost of standard insulin treatment in type 1 patients with that of intensified treatment as well as the direct cost of their complications during the two treatment modes for 35 years' duration of disease. According to our model calculations, the direct cost of basic intensified insulin treatment is $3300 per year, about three times more than that of the standard insulin treatment. However, for the period of 35 years, the cost of complications associated with intensified insulin treatment is lower, while the total cost of intensified treatment, over 35 years, is higher than that of the standard treatment. Thus, looking from the health provider point of view and relating only to economic analysis, intensified insulin treatment encompassing all type 1 patients is not cost-beneficial. Therefore, the decision to adopt this type of therapy should be based on the combination of medical, ethical, political, and economical principles, and applied to selected, well motivated, and prepared patient groups, in whom compliance to intensified treatment would be expected to prevent or delay the onset of complications. According to cost analysis, nephropathy is the most common and severest complication, and intensive treatment promises to be most effective in this group of patients.