Purpose: Early identification of cardiovascular risk in diabetes patients is critical to implement therapeutic interventions to decrease morbidity and mortality. We evaluate and compare cholesterol management guidelines for patients with Type 2 diabetes, on the basis of quality adjusted life years and the total discounted cost of therapy, as well as hospitalization and follow-up care for cardiovascular events.

Methodology: Using clinical data from the Mayo Clinic electronic medical record we construct a natural history model for Type 2 diabetes. The population is defined as patients with Type 2 diabetes, age 40 years and older, with at least 10 years of follow-up after the initial encounter. Our model is based on a discrete time (1 year) Markov process that defines the probabilistic progression of patients through health states defined by cardiovascular events, and metabolic factors including: total cholesterol, high density lipoproteins (HDL), triglycerides, systolic blood pressure, and HbA1C. We use our natural history model to evaluate several published treatment guidelines including Adult Treatment Panel (ATP) II, ATP III, and Canadian. For each guideline we evaluate expected quality adjusted life years and total discounted costs associated with statin treatment and diabetes related complications.

Results: We find that both quality-adjusted life years and costs depend on treatment guidelines, however, variation in costs across guidelines are more significant. The difference in expected quality adjusted life years between guidelines is less than one year. The mean total costs for males were consistently higher across guidelines and health states compared to females. The maximum differences in costs across all risk state for males and females are $6570 and $5680 respectively. For the study population, ranked by increasing cost, the guidelines have the following order for females: Canadian, ATP II, ATP III. For males the order is as follows: ATP II, Canadian, ATP III.

Conclusions: Based on our natural history model we find that there are differences in cost for cholesterol management guidelines but relatively little difference quality adjusted life years.