Modelling the Clinical and Complication-Related Economic Burden of Therapeutic Inertia in People With Type 2 Diabetes...

To quantify the long-term clinical and complication-related economic burden of therapeutic inertia in type 2 diabetes mellitus (T2DM) in China, focusing on delayed insulin initiation and intensification.

A health economic analysis was conducted from the perspective of the Chinese healthcare system using the validated CORE Diabetes Model. Two cohorts were simulated to compare timely versus delayed insulin initiation and intensification. Base-case assumptions included a baseline HbA1c of 9.0%, a 5-year treatment delay and a 30-year time horizon. Model inputs, including patient characteristics, treatment effects, costs and utilities, were sourced from published literature, prioritising Chinese data. Outcomes included quality-adjusted life years (QALYs), complication incidence and complication-related direct medical costs, with scenario analyses performed to test robustness. Results were also extrapolated to the national population of Chinese patients with uncontrolled T2DM.

Timely insulin initiation was associated with an average saving of ¥11 370 per patient and a gain of 0.086 QALYs compared with a 5-year delay. Timely intensification yielded cost savings of ¥10 417 and an incremental 0.093 QALYs per patient. At the population level, these corresponded to total savings of ¥68.2 billion and ¥62.5 billion, and additional 515 604 and 557 572 QALYs, respectively. Scenario analyses confirmed that health and cost benefits increased with higher baseline HbA1c and longer time horizons.

Therapeutic inertia in T2DM management imposes quantifiable QALY losses and complication-related cost burdens in China. Timely insulin initiation and intensification significantly improve outcomes and reduce costs, underscoring the urgency of overcoming therapeutic inertia through patient, physician and system-level strategies.