Does weight loss add value to blood pressure control among patients with diabetic kidney disease?

Abstract

Obesity is an independent risk factor for development and progression of diabetic kidney disease (DKD). Whether weight loss provides any additional benefit beyond blood pressure (BP) control is unclear. To simulate a trial, we used the Archimedes model, a person-specific simulation model including detailed representations of physiology, diseases, and health care systems. Our population-based sample represented individuals diagnosed with type 2 diabetes and DKD drawn from 1999-2006 cohorts of NHANES. Simulations were generated to estimate costs and health outcomes across time for 3 treatment strategies: (1) standard of care (STD); (2) blood pressure control (BP); and (3) BP combined with 5% weight loss (BPWT). BP control represents 3.5%&6% reductions for those with SBP>130 and SBP>140, respectively. Over a 20y time horizon, discounted costs for the STD group were $165,261 with discounted quality adjusted life-years (QALYs) of 5.89. With BP estimated at $30/month, the incremental cost-effectiveness ratio (ICER) was $26,626/QALY compared to STD. With BPWT at $50/month, the ICER was $31,773 compared to STD. Even with varying intervention costs and durations (Figure), the ICERs remained favorable, especially for the BPWT group.In conclusion, weight loss in addition to BP control appears to provide favorable value, particularly over moderate time horizons.fx1