Impact of Simulated Risk Factor Management on Cardiovascular Disease and Costs in Type 2 Diabetes Using the ABC Model

Aims: We evaluated the impact of scenario-based multifactorial control on the 3-year incidence of fatal/non-fatal cardiovascular disease (CVD) and associated healthcare costs in Asian patients with type 2 diabetes (T2D). Materials and Methods: We applied the validated ‘ABC’ model to simulate the 3-year impact of attaining multiple treatment targets (HbA_1c < 7%, blood pressure [BP] < 130/80 mmHg, risk-stratified LDL-C target [ABC], smoking cessation and weight reduction) on the incidence of fatal/non-fatal CVD (ischaemic heart disease and stroke) in patients with T2D enrolled from 11 Asian countries/jurisdictions in the Joint Asia Diabetes Evaluation (JADE) Register. We estimated the costs of these simulated CVD events and potential cost savings with multifactorial intervention. Results: Amongst 103 958 patients with T2D (53.4% men, 12.0% current smokers, mean [SD] age 57.6 [11.8], HbA_1c 7.96 [1.87], systolic BP 132.0 [17.4] mmHg, LDL-C 2.6 [0.95] mmol/L, BMI 26.2 [4.5] kg/m²), 17 151 (16.5%) had prior CVD and 86 807 (83.5%) had no CVD at baseline. In the CVD group, 1.5% achieved all three ABC targets and 5.1% in the nonCVD group at baseline. In the CVD group, the estimated incidence rate for CVD was 61.60 per 1000-person-years (PY), and 11.65 per 1000-PY in the non-CVD group. Simulated achievement of all three ABC targets reduced the incidence rates by 35.1%–40.01% per 1000-PY in the CVD group and by 30.2%–8.13% per 1000-PY in the non-CVD group. In China, these scenario-based simulations might avert 1 177 682 CVD events per year with a potential saving of US$ 11 292 823 476. Conclusions: Multifactorial management of cardiometabolic risk factors may have a substantial impact on CVD prevention, with cost savings in patients with T2D.