Table 5.
Modelled combined effect of increased hypertension and diabetes diagnosis to 60% or 80%; increased blood pressure, glycaemia, and statin treatment to 60% or 80%; and increased blood pressure and glucose control to 60% or 80%, on risk of diabetes complications
| Central Asia | East Asia | South Asia | Southeast Asia | North Africa and Middle East | Eastern sub-Saharan Africa | Western sub-Saharan Africa | Southern sub-Saharan Africa | |
|---|---|---|---|---|---|---|---|---|
| Baseline risk | ||||||||
| 10-year estimated cardiovascular event risk | 13·00% (5·00 to 26·00) | 17·00% (11·00 to 25·00) | 6·00% (0·00 to 11·00) | 8·00% (4·00 to 13·00) | 17·00% (9·00 to 25·00) | 6·00% (0·00 to 11·00) | 3·00% (0·00 to 8·00) | 10·00% (6·00 to 17·00) |
| 10-year estimated heart failure risk | 2·95% (1·35 to 6·31) | 2·84% (1·30 to 5·54) | 1·86% (1·04 to 3·45) | 2·63% (1·41 to 5·04) | 3·06% (1·55 to 6·15) | 1·69% (0·81 to 3·19) | 0·93% (0·48 to 2·01) | 3·20% (1·52 to 6·60) |
| 10-year estimated end-stage renal disease risk | 7·26% (5·75 to 9·33) | 5·69% (4·52 to 7·38) | 7·68% (5·89 to 9·66) | 7·12% (5·61 to 9·34) | 6·67% (5·18 to 8·81) | 7·41% (5·64 to 9·56) | 7·79% (6·27 to 9·83) | 6·11% (4·78 to 7·91) |
| 10-year estimated severe vision loss risk | 6·67% (4·61 to 9·48) | 6·66% (4·84 to 9·27) | 4·94% (3·69 to 6·68) | 6·17% (4·46 to 8·73) | 6·32% (4·49 to 8·81) | 4·70% (3·22 to 6·90) | 3·81% (2·72 to 5·55) | 6·45% (4·39 to 9·20) |
| 10-year estimated pressure sensation loss risk | 8·57% (5·54 to 12·67) | 8·91% (5·94 to 13·19) | 6·70% (4·56 to 9·52) | 7·75% (5·21 to 11·46) | 8·13% (5·48 to 12·04) | 6·23% (3·81 to 9·18) | 4·69% (2·93 to 7·46) | 8·21% (5·35 to 12·13) |
| DALYs per 1000 population over 10 years | ||||||||
| Baseline DALYs | 8197 (7872 to 8527) | 804 (786 to 822) | 2887 (2812 to 2964) | 8740 (8340 to 9130) | 11 079 (10 797 to 11 353) | 12 152 (11 463 to 12 880) | 10 798 (10 287 to 11 321) | 4058 (3855 to 4276) |
| 60% treatment, 60% control | 7794 (7472 to 8121) | 778 (760 to 797) | 2850 (2776 to 2926) | 8555 (8158 to 8943) | 10 572 (10 294 to 10 843) | 11 992 (11 306 to 12 715) | 10 755 (10 245 to 11 275) | 3952 (3751 to 4169) |
| 60% treatment, 80% control | 7794 (7472 to 8121) | 778 (760 to 797) | 2850 (2776 to 2926) | 8555 (8158 to 8943) | 10 572 (10 294 to 10 843) | 11 992 (11 306 to 12 715) | 10 755 (10 245 to 11 275) | 3952 (3751 to 4169) |
| 80% treatment, 60% control | 7686 (7364 to 8010) | 771 (753 to 789) | 2838 (2765 to 2915) | 8495 (8096 to 8883) | 10 415 (10140 to 10686) | 11 941 (11 254 to 12 662) | 10 735 (10 227 to 11 254) | 3917 (3718 to 4137) |
| 80% treatment, 80% control | 7636 (7315 to 7959) | 768 (750 to 787) | 2835 (2761 to 2911) | 8475 (8078 to 8862) | 10 361 (10 085 to 10 631) | 11 921 (11 234 to 12 643) | 10 730 (10 222 to 11 249) | 3904 (3705 to 4123) |
| 60% diagnosis, 60% treatment, 60% control | 7746 (7425 to 8073) | 767 (749 to 785) | 2838 (2764 to 2914) | 8516 (8120 to 8901) | 10 558 (10 280 to 10 829) | 11 925 (11242 to 12648) | 10 653 (10 147 to 11 173) | 3934 (3734 to 4151) |
| 60% diagnosis, 60% treatment, 80% control | 7746 (7425 to 8073) | 767 (749 to 785) | 2838 (2764 to 2914) | 8516 (8120 to 8901) | 10 558 (10 280 to 10 829) | 11 925 (11242 to 12648) | 10 653 (10 147 to 11 173) | 3934 (3734 to 4151) |
| 60% diagnosis, 80% treatment, 60% control | 7620 (7299 to 7945) | 756 (738 to 775) | 2815 (2742 to 2891) | 8405 (8018 to 8793) | 10 395 (10 119 to 10 664) | 11 833 (11 150 to 12 549) | 10 581 (10 082 to 11 097) | 3895 (3696 to 4114) |
| 60% diagnosis, 80% treatment, 80% control | 7559 (7240 to 7884) | 753 (735 to 771) | 2805 (2733 to 2882) | 8370 (7986 to 8758) | 10 334 (10 059 to 10 604) | 11 776 (11 095 to 12 489) | 10 557 (10 059 to 11 073) | 3880 (3682 to 4098) |
| 80% diagnosis, 60% treatment, 60% control | 7687 (7366 to 8013) | 759 (741 to 777) | 2828 (2755 to 2905) | 8480 (8085 to 8865) | 10 504 (10 227 to 10 774) | 11 882 (11 200 to 12 603) | 10 615 (10 110 to 11 132) | 3912 (3711 to 4127) |
| 80% diagnosis, 60% treatment, 80% control | 7687 (7366 to 8013) | 759 (741 to 777) | 2828 (2755 to 2905) | 8480 (8085 to 8865) | 10 504 (10 227 to 10 774) | 11 882 (11 200 to 12 603) | 10 615 (10 110 to 11 132) | 3912 (3711 to 4127) |
| 80% diagnosis, 80% treatment, 60% control | 7545 (7223 to 7867) | 745 (728 to 764) | 2799 (2727 to 2876) | 8354 (7967 to 8741) | 10 316 (10 043 to 10 586) | 11 769 (11 084 to 12 480) | 10 530 (10 033 to 11 043) | 3867 (3669 to 4084) |
| 80% diagnosis, 80% treatment, 80% control | 7476 (7156 to 7799) | 741 (724 to 760) | 2792 (2719 to 2868) | 8318 (7934 to 8705) | 10 247 (9974 to 10 517) | 11 714 (11 033 to 12 426) | 10 503 (10 007 to 11 017) | 3850 (3652 to 4066) |
| Costs ($1000 per 1000 population over 10 years)* | ||||||||
| Baseline costs | 16 204 (15 679 to 16 705) | 2023 (1988 to 2061) | 4406 (4317 to 4495) | 17 914 (17 349 to 18 526) | 19 718 (19 322 to 20 108) | 19 323 (18 481 to 20 199) | 15 170 (14 581 to 15 765) | 8088 (7776 to 8382) |
| 60% treatment, 60% control | 16 135 (15 579 to 1 6613) | 2080 (2041 to 2117) | 4437 (4344 to 4524) | 18 272 (17 663 to 18 864) | 19 779 (19 343 to 20 135) | 19 488 (18 621 to 20 350) | 15 266 (14 668 to 15 859) | 8101 (7774 to 8382) |
| 60% treatment, 80% control | 16 135 (15 579 to 16 613) | 2080 (2041 to 2117) | 4437 (4344 to 4524) | 18 272 (17 663 to 1 8864) | 19 779 (19 343 to 20 135) | 19 488 (18 621 to 20 350) | 15 266 (14 668 to 15 859) | 8101 (7774 to 8382) |
| 80% treatment, 60% control | 16 113 (15 557 to 16 591) | 2090 (2051 to 2127) | 4444 (4352 to 4530) | 18 366 (17 756 to 18 954) | 19 784 (19 352 to 20 139) | 19 518 (18 648 to 20 381) | 15 280 (14 683 to 15 873) | 8098 (7771 to 8377) |
| 80% treatment, 80% control | 16 155 (15 599 to 16 631) | 2115 (2076 to 2152) | 4454 (4361 to 4539) | 18 509 (17 899 to 19 096) | 19 874 (19 440 to 20 227) | 19 563 (18 694 to 20 425) | 15 306 (14 709 to 15 899) | 8123 (7796 to 8401) |
| 60% diagnosis, 60% treatment, 60% control | 16 219 (15 659 to 16 693) | 2132 (2092 to 2168) | 4460 (4365 to 4544) | 18 579 (17 964 to 19 168) | 19 793 (19 356 to 20 148) | 19 647 (18 765 to 20 494) | 15 630 (15 019 to 16 213) | 8126 (7797 to 8405) |
| 60% diagnosis, 60% treatment, 80% control | 16 219 (15 659 to 16 693) | 2132 (2092 to 2168) | 4460 (4365 to 4544) | 18 579 (17 964 to 19 168) | 19 793 (19 356 to 20 148) | 19 647 (18 765 to 20 494) | 15 630 (15 019 to 16 213) | 8126 (7797 to 8405) |
| 60% diagnosis, 80% treatment, 60% control | 16 194 (15 637 to 16 667) | 2147 (2107 to 2183) | 4463 (4369 to 4544) | 18 675 (18 061 to 19 261) | 19 797 (19 367 to 20 151) | 19 669 (18 787 to 20 508) | 15 677 (15 066 to 16 250) | 8126 (7796 to 8403) |
| 60% diagnosis, 80% treatment, 80% control | 16 252 (15 693 to 16 720) | 2183 (2144 to 2219) | 4474 (4377 to 4555) | 18 864 (18 251 to 19 451) | 19 882 (19 448 to 20 234) | 19 725 (18 837 to 20 565) | 15 759 (15 149 to 16 333) | 8155 (7826 to 8431) |
| 80% diagnosis, 60% treatment, 60% control | 16 286 (15 719 to 16 753) | 2177 (2136 to 2212) | 4478 (4382 to 4562) | 18 814 (18 192 to 19 399) | 19 846 (19 406 to 20 197) | 19 756 (18 869 to 20 596) | 15 789 (15 171 to 16 368) | 8159 (7827 to 8435) |
| 80% diagnosis, 60% treatment, 80% control | 16 286 (15 719 to 16 753) | 2177 (2136 to 2212) | 4478 (4382 to 4562) | 18 814 (18 192 to 19 399) | 19 846 (19 406 to 20 197) | 19 756 (18 869 to 20 596) | 15 789 (15 171 to 16 368) | 8159 (7827 to 8435) |
| 80% diagnosis, 80% treatment, 60% control | 16 260 (15 698 to 16 727) | 2196 (2155 to 2231) | 4482 (4386 to 4561) | 18 931 (18 317 to 19 519) | 19 844 (19 412 to 20 196) | 19 783 (18 892 to 20 621) | 15 859 (15 239 to 16 426) | 8160 (7829 to 8434) |
| 80% diagnosis, 80% treatment, 80% control | 16 331 (15 769 to 16 796) | 2242 (2201 to 2276) | 4497 (4398 to 4577) | 19 167 (18 552 to 19 752) | 19 933 (19 502 to 20 288) | 19 869 (18 973 to 20 692) | 15 967 (15 349 to 16 535) | 8197 (7864 to 8469) |
| Incremental cost-effectiveness ratio (change in $ per change in DALYS)* | ||||||||
| 60% treatment 60% control | −230 (−246 to −171) | 2162 (2064 to 2229) | 773 (725 to 846) | 1854 (1675 to 1935) | 54 (42 to 120) | 963 (852 to 1031) | 2188 (1882 to 2236) | 4 (−20 to 122) |
| 60% treatment 80% control | −230 (−246 to −171) | 2162 (2064 to 2229) | 773 (725 to 846) | 1854 (1675 to 1935) | 54 (42 to 120) | 963 (852 to 1031) | 2188 (1882 to 2236) | 4 (−20 to 122) |
| 80% treatment, 60% control | −225 (−236 to −179) | 1991 (1909 to 2038) | 722 (718 to 793) | 1751 (1645 to 1843) | 47 (46 to 101) | 870 (764 to 924) | 1734 (1511 to 1790) | −34 (−40 to 71) |
| 80% treatment, 80% control | −133 (−140 to −88) | 2556 (2477 to 2602) | 857 (847 to 916) | 2171 (2051 to 2238) | 168 (163 to 217) | 990 (896 to 1041) | 1988 (1763 to 2045) | 126 (126 to 224) |
| 60% diagnosis, 60% treatment, 60% control | −27 (−43 to 33) | 2909 (2810 to 2983) | 1014 (967 to 1090) | 2914 (2690 to 2971) | 78 (65 to 144) | 1340 (1225 to 1428) | 3171 (2951 to 3200) | 191 (167 to 304) |
| 60% diagnosis, 60% treatment, 80% control | −27 (−43 to 33) | 2909 (2810 to 2983) | 1014 (967 to 1090) | 2914 (2690 to 2971) | 78 (65 to 144) | 1340 (1225 to 1428) | 3171 (2951 to 3200) | 191 (167 to 304) |
| 60% diagnosis, 80% treatment, 60% control | −67 (−73 to −18) | 2571 (2501 to 2622) | 727 (694 to 798) | 2271 (2112 to 2280) | 66 (64 to 117) | 987 (923 to 1083) | 2334 (2159 to 2365) | 130 (123 to 232) |
| 60% diagnosis, 80% treatment, 80% control | 24 (22 to 75) | 3117 (3051 to 3167) | 747 (737 to 826) | 2565 (2424 to 2609) | 171 (169 to 221) | 996 (910 to 1067) | 2445 (2290 to 2488) | 282 (278 to 374) |
| 80% diagnosis, 60% treatment, 60% control | 94 (78 to 160) | 3336 (3244 to 3423) | 1161 (1111 to 1234) | 3415 (3175 to 3461) | 157 (145 to 223) | 1511 (1399 to 1600) | 3370 (3124 to 3408) | 366 (341 to 481) |
| 80% diagnosis, 60% treatment, 80% control | 94 (78 to 160) | 3336 (3244 to 3423) | 1161 (1111 to 1234) | 3415 (3175 to 3461) | 157 (145 to 223) | 1511 (1399 to 1600) | 3370 (3124 to 3408) | 366 (341 to 481) |
| 80% diagnosis, 80% treatment, 60% control | 34 (30 to 86) | 2913 (2858 to 2986) | 793 (771 to 862) | 2631 (2490 to 2662) | 118 (116 to 166) | 1115 (1027 to 1198) | 2570 (2367 to 2605) | 281 (273 to 378) |
| 80% diagnosis, 80% treatment, 80% control | 127 (124 to 176) | 3468 (3411 to 3528) | 873 (854 to 951) | 2966 (2828 to 3020) | 219 (216 to 259) | 1147 (1083 to 1246) | 2700 (2522 to 2752) | 429 (420 to 523) |
Data are median (IQR). Control for blood pressure was defined as a systolic blood pressure of less than 130 mm Hg and a diastolic blood pressure of less than 80 mm Hg. Control for glycaemia was defined as a glycated haemoglobin of 7% or less (53 mmol/mol), or a fasting plasma glucose of less than 7 mmol/L (126 mg/dL). We estimated the DALY effect of cardiovascular diseases (defined as fatal and non-fatal myocardial infarction and stroke), congestive heart failure (ejection fraction of <40%, with New York Heart Association class III or IV functional limitations), end-stage renal disease (defined as estimated glomerular filtration rate <15 mL/min per 1·73 m2 or needing dialysis or transplant), retinopathy with severe vision loss (<20/200 visual acuity as measured by the Snellen chart), neuropathy (as measured by pressure sensation loss via the Semmes-Weinstein 5·07/10 g monofilament examination). Costs and DALYs were computed over a 10-year policy planning time horizon, simulating all persons alive or born within the next 10 years, at a 3% annual discount rate. Negative values for the incremental cost-effectiveness ratio indicate cost-savings. Overall estimates are population weighted. We note that in some cases, the incremental effect of changing diagnosis, treatment, or control rates are sufficiently small that some rows are the same as others, when subject to rounding. Costs are rounded to the nearest $1000 per 1000 population. DALYs=disability-adjusted life-years.
*
2020 International Dollars.