Supplementary Text 1. Model Simulation
We developed a microsimulation model, which simulates health risk factors associated with type II diabetes (T2D), T2D-related
microvascular diseases, cardiovascular diseases (myocardial infarction (MI), stroke risk) at the level of the individual. The model is stochastic
by sampling from probability distributions of input parameters to generate a distribution of outcomes. The model is run in discrete time steps
over the life-course from 2019, where the simulated policy changes are introduced at the start of year 2019. A model diagram is illustrated in
Figure 1. Key parameters and data sources are summarized in Appendix Tables S6-S19.
We classified synthetic population in this model by combinations of a few key demographic characteristics: age (30-49,50-64,65+ years old),
sex, race/ethnicity (NHANES categories of non-Hispanic white, non-Hispanic black, Mexican-American or other), and income (relative to the
FPL, adjusted for household size). Because NHANES is repeated cross-sectional, we had to construct synthetic population to account for the
weights. 10,000 individuals were generated, per ISPOR guidelines, for each cohort defined by the combinations of these characteristics. The
model was re-run 10,000 times while repeatedly Monte Carlo sampling from the probability distributions of all input parameters to capture
uncertainties in our estimates.
1The multiple baseline T2D and cardiovascular diseases (CVD) risk factors and prevalent disease cases were assigned to each simulated
individual by repeated Monte Carlo sampling from the probability distributions of each of these variables in NHANES, specific to each
demographic group. The joint probability distributions of these risk factors were accounted for using multivariate sampling with copula
functions, which allow us to capture how these factors are co-dependent. This procedure exclusively takes into account strong correlation
between risk factors. To account for individuals aging, we tracked the age of each simulated individual over the simulation period, and
updated each individual’s risk factors to account for their age-specific consumption patterns and health risks by preserving the individual’s
rank in the population distribution to account for the stability of risk over time and differential survival probability.
Supplementary Text 2. Risk of myocardial infarction (MI) or stroke
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
minorities
8; furthermore, the Framingham equations separately predict coronary heart disease and stroke, which have different implications
for mortality and quality of life.
9In addition, Framingham functions include diabetes status that the increased relative risk of heart disease and
stroke from co-morbid diabetes is captured in our model.
Given no history of MI (x = age in years),
Male:
y
0.0001*
e
0.0312x[6]
Female:
y
8
E
06*
e
0.0599x[7]
Given no history of stroke (x = age in years),
Male:
y
9
E
06*
e
0.0622x[8]
Female:
y
3
E
06*
e
0.0741x[9]
Given history of CVD, the risk of MI or stroke without a history of CVD was multiplied by a constant with a mean of 2, standard deviation
1.0204, gamma distribution (shape=3.84166,scale=0.520608).
In order to account for other CVD risk factors, we adopted a previously-published approach in which weights are assigned to each individual
based on the following risk factors used in Framingham risk equations,
10,11age, total cholesterol, HDL cholesterol, hypertension treatment
status, smoking, and diabetes. Individual Framingham risks were divided by the mean Framingham risk of each cohort (defined by age, sex,
race, and income), then used to weight each individual’s baseline MI and stroke risk equations, Equations [6]-[9].
For male,
Individual_FHS_risk =
(1-0.88936)*exp((3.06117*log(age)+1.12370*log(total_cholesterol)-0.93263*log(HDL_cholesterol)+1.99881*log(SBP_treated)+1.93303*log(SBP_untreated)+0.65451*smoking+0.57367*diabetes)- 23.9802)
For female,
Individual_FHS_risk =
(1-0.95012)*exp((2.32888*log(age)+1.20904*log(total_cholesterol)-0.70833*log(HDL_cholesterol)+2.82263*log(SBP_treated)+2.76157*log(SBP_untreated)+0.52873*smoking+0.69154*diabetes)-26.1931)
Individual FHS risk
Weights assigned toindividual
Mean FHS risk of each cohort
Supplementary Text 3. Mortality after myocardial infarction (MI) or stroke
We used validated equations of age- and sex-specific risk of mortality after MI and stroke developed by fitting exponential curves to the ratio
of incidence of fatal event to total incidence of event. Fatal MI and total incidence of MI data was from the Framingham Heart Study. The
ratio of fatal stroke to stroke incidence was obtained from the Cardiovascular Health Study.
2,3After MI (x = age in years),
Male:
y
0.0289*
e
0.0269xFemale:
y
0.0004*
e
0.0706xAfter stroke (x = age in years),
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
Supplementary Text 4. Risk Equations for Complications of type 2 Diabetes (RECODe)
Risk equations for microvascular and cardiovascular complications of type 2 diabetes, developed using a large intervention study and
validated in two randomized trials and two longitudinal cohort studies.
12,13The following table provides the RECODe coefficients.
Neuropathy Retinopathy Nephropathy
Demographics Age, years 0.03022 0.02285 -0.01938 Women -0.1868 0.2264 -0.01129 Ethnicity Black -0.09448 -0.1677 0.08812 Hispanic or Latino 0.2338 Clinical features
Tobacco smoking, current 0.1483
SBP (mmHg) 0.00456 0.00824 0.00303 History of CVD 0.26672 0.1127 -0.02164 Drug use BP lowering drugs 0.18192 0.06393 -0.07952 Statins Anticoagulants 0.03199
Oral diabetes drugs -0.25747 -0.2349 -0.1256
Biomarkers
HbA1c, % 0.18866 0.1449 0.1369
Total cholesterol, mg/dL 0.00219 -0.00017 -0.00111
HDL cholesterol, mg/dL -0.00539 0.00545 0.00629
Serum creatine, mg/DL 0.604442 0.6947 0.8609
Urine albumin:creatine ratio, mg/g
0.0002 0.00036
The 10-year risk of an outcome can be computed as 1 – λ^exp (Σ (βx) – mean (Σ (βx))),
where β are the equation coefficients and x are the values for each covariate for an individual patient within the cohort under study.
on any medications, and with HbA1c of 8%, total cholesterol of 190 mg/dL, HDL of 50 mg/dL, serum creatinine 1.1 mg/dL, and urine
microalbumin:creatinine ratio of 10 mg/g would have a risk of renal failure/end-stage renal disease of 1–0.973^exp(–0.01938*60 +
0.003027*140 + 0.1369* 8-0.001112*190 + 0.006289* 50 + 0.8609*1.1 + 0.000362*10–0.23) = 0.085 or a 8.5% 10-year risk.
The impact of 1% reduction in HbA1c on microvascular diseases can be estimated with exp(β
HbA1c) for each disease outcome (retinopathy,
neuropathy, and nephropathy)
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
Supplementary Figure 1. Periodontitis (moderate and severe) prevalence.
We considered our targets were met if the projected prevalence
rates were within
<5% absolute error between our model and the NHANES.
14Supplementary Figure 2. MI incidence.
We considered our targets were met if the projected incidence fell within the interval between the
estimates from Framingham Heart Study (FHS) and
Atherosclerosis Risk in Communities study (ARIC),
more-inclusive and less-inclusive
measures of composite
CVD outcomes
3,15,16Supplementary Figure 3. Stroke Incidence.
We considered our targets were met if the projected incidence fell within the interval between
the estimates from Framingham Heart Study (FHS) and
: Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS)
3,15,16©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
Supplementary Table 1. Baseline type II diabetes prevalence (%)
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low 9.9 2.7 20.0 4.3 30.0 7.3
Middle 5.7 2.5 24.3 5.0 26.8 7.3 High 4.6 2.3 24.1 5.9 34.1 11.2 NH White Low 3.9 1.0 14.6 3.1 23.2 4.6 Middle 4.5 1.6 14.9 3.5 25.2 3.5 High 4.1 1.0 9.8 1.8 18.8 2.4 NH Black Low 8.3 2.5 17.8 3.5 30.1 5.0 Middle 8.5 2.5 22.6 4.0 36.4 4.8 High 5.5 1.8 23.1 3.9 31.7 5.2
Female Mexican Low 10.3 2.3 28.8 5.3 38.8 6.8
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
Supplementary Table 2. Baseline chronic periodontitis prevalence (%)
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low 66.0 4.1 79.2 4.4 63.4 7.5
Middle 55.8 4.8 76.2 4.7 81.2 6.3 High 29.6 5.6 58.3 7.1 61.3 10.6 NH White Low 39.9 3.7 54.3 4.9 37.2 4.8 Middle 30.0 3.5 57.8 5.3 52.4 3.8 High 17.4 1.9 37.7 2.7 48.2 3.1 NH Black Low 61.4 4.5 78.6 3.6 51.9 5.4 Middle 49.4 4.5 67.7 4.4 58.9 4.9 High 39.9 4.0 62.1 4.3 61.2 5.3
Female Mexican Low 37.6 3.7 65.1 5.5 62.4 6.7
Supplementary Table 3. Baseline MI history prevalence (%)
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low 1.3 1.0 9.3 4.5 7.1 3.7
Middle 0.4 0.4 9.1 6.7 NA NA High NA NA 10.6 9.5 19.8 10.4 NH White Low 2.6 1.8 16.5 6.6 30.0 5.7 Middle 0.5 0.5 9.8 3.4 23.2 4.8 High 0.3 0.3 5.4 1.4 20.0 3.7 NH Black Low 2.3 2.3 15.9 5.4 19.3 2.1 Middle NA NA 11.2 5.5 9.3 1.6 High NA NA 7.1 2.8 12.6 1.7
Female Mexican Low 6.4 1.7 4.6 1.4 13.0 2.3
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
Supplementary Table 4. Baseline stroke history prevalence (%)
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low 3.1 1.5 NA NA 10.0 1.8
Middle 0.5 0.5 2.3 1.2 13.4 3.1 High 2.7 1.3 7.1 2.3 7.7 2.3 NH White Low 5.3 1.1 3.1 1.1 9.6 2.5 Middle 0.3 0.2 5.4 0.9 23.6 2.6 High 0.2 0.2 4.9 1.1 20.4 1.5 NH Black Low 3.6 1.3 0.8 0.3 3.2 0.4 Middle 0.5 0.5 6.7 1.3 21.8 2.3 High 3.1 1.5 3.4 0.7 15.8 1.7
Female Mexican Low 11.0 1.6 7.8 1.6 7.0 1.2
Supplementary Table 5. Baseline hypertension medication use prevalence (%)
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low 5.3 1.9 22.4 4.5 43.1 7.7
Middle 7.5 2.7 21.0 4.4 59.4 8.2 High 9.7 3.7 32.0 6.7 55.7 11.2 NH White Low 11.3 2.0 31.9 4.5 44.9 5.0 Middle 11.7 2.6 33.1 4.8 50.1 3.8 High 12.0 1.6 31.5 2.6 52.7 3.1 NH Black Low 17.0 3.5 42.4 4.5 65.6 5.1 Middle 20.2 3.7 43.0 4.7 61.7 4.7 High 16.7 3.0 45.8 4.4 72.6 4.8
Female Mexican Low 8.1 2.2 32.1 5.3 52.7 6.8
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
Supplementary Table 6. Baseline statin use prevalence (%)
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low 1.5 1.1 3.1 1.9 6.1 3.7
Middle 1.2 0.8 10.5 3.4 2.7 2.6 High 2.4 1.7 8.6 3.7 18.1 8.7 NH White Low 2.3 1.1 4.8 2.8 8.7 2.9 Middle 3.5 1.5 10.0 3.0 12.4 2.5 High 4.5 1.0 12.2 1.9 14.6 2.1 NH Black Low 1.9 1.3 2.0 0.9 9.2 2.9 Middle 1.8 1.2 7.2 2.4 11.0 3.1 High 2.7 1.2 10.0 2.7 10.8 3.3
Female Mexican Low 0.8 0.8 4.7 2.4 7.9 3.7
Supplementary Table 7. Baseline anticoagulant use prevalence (%)
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low NA NA NA NA 0.0 0.0
Middle NA NA NA NA 0.0 0.0 High NA NA NA NA 0.0 0.0 NH White Low 0.3 0.2 1.6 0.7 2.8 0.7 Middle 0.0 0.0 0.5 0.4 1.9 0.5 High 0.2 0.2 0.6 0.3 1.0 0.3 NH Black Low 0.6 0.6 0.1 0.1 1.7 0.7 Middle NA NA 0.3 0.3 0.5 0.4 High NA NA 1.2 0.7 0.9 0.4
Female Mexican Low NA NA 0.2 0.2 0.0 0.0
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
Supplementary Table 8. Baseline smoking prevalence (%)
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low 25.4 3.7 19.2 4.2 12.8 4.7
Middle 14.0 3.5 17.2 4.3 9.4 4.7 High 22.6 5.4 16.2 5.2 17.6 8.4 NH White Low 51.4 3.7 47.0 4.9 21.7 3.9 Middle 26.5 3.3 26.9 4.5 9.1 2.5 High 14.4 1.7 13.1 1.9 6.5 1.6 NH Black Low 51.2 4.6 51.7 4.5 21.1 4.4 Middle 35.2 4.3 38.7 4.6 28.9 4.4 High 14.4 2.8 22.0 3.7 13.8 3.6
Female Mexican Low 10.1 2.4 10.3 3.3 17.2 5.6
Supplementary Table 9. Baseline HbA1c (% )
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low 5.7 1.0 6.3 1.0 6.3 1.0
Middle 5.6 1.0 6.3 1.0 6.1 1.0 High 5.5 1.0 6.1 1.0 6.2 1.0 NH White Low 5.5 1.0 5.8 1.0 6.0 1.0 Middle 5.4 1.0 5.8 1.0 5.9 1.0 High 5.4 1.0 5.7 1.0 5.9 1.0 NH Black Low 5.8 1.0 5.9 1.0 6.1 1.0 Middle 5.7 1.0 6.0 1.0 6.2 1.0 High 5.8 1.0 6.1 1.0 6.1 1.0
Female Mexican Low 5.7 1.0 6.3 1.0 6.4 1.0
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
Supplementary Table 10. Baseline systolic blood pressure (mmHg)
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low 121.8 1.0 124.2 1.0 137.6 1.0
Middle 120.1 1.0 128.9 1.0 138.5 1.0 High 118.5 1.0 129.8 1.0 133.6 1.0 NH White Low 120.7 1.0 124.0 1.0 130.4 1.0 Middle 119.2 1.0 125.0 1.0 128.3 1.0 High 118.3 1.0 124.2 1.0 128.2 1.0 NH Black Low 128.0 1.0 133.3 1.0 135.8 1.0 Middle 125.1 1.0 130.4 1.0 136.4 1.0 High 123.1 1.0 127.6 1.0 134.4 1.0
Female Mexican Low 114.8 1.0 124.6 1.0 133.3 1.0
Supplementary Table 11. Baseline Total Cholesterol (mmol/L)
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low 202.8 1.0 190.8 1.0 183.4 1.0
Middle 202.1 1.0 203.4 1.0 192.9 1.0 High 194.6 1.0 201.2 1.0 184.2 1.0 NH White Low 197.9 1.0 185.3 1.0 175.3 1.0 Middle 195.2 1.0 186.9 1.0 173.9 1.0 High 197.3 1.0 192.5 1.0 170.7 1.0 NH Black Low 188.2 1.0 191.5 1.0 174.2 1.0 Middle 192.2 1.0 184.9 1.0 173.9 1.0 High 202.8 1.0 181.5 1.0 169.9 1.0
Female Mexican Low 194.0 1.0 195.1 1.0 189.9 1.0
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
Supplementary Table 12. Baseline HDL Cholesterol (mmol/L)
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low 43.8 1.0 44.6 1.0 45.6 1.0
Middle 43.3 1.0 41.2 1.0 47.8 1.1 High 43.8 1.0 43.6 1.0 47.7 1.1 NH White Low 44.0 1.0 42.4 1.0 45.9 1.0 Middle 42.6 1.0 46.4 1.0 47.3 1.0 High 45.5 1.0 46.8 1.0 48.9 1.0 NH Black Low 50.4 1.0 51.0 1.0 49.8 1.0 Middle 49.1 1.0 49.4 1.0 49.3 1.0 High 48.2 1.0 49.2 1.0 51.7 1.0
Female Mexican Low 50.1 1.0 51.6 1.0 52.7 1.0
Supplementary Table 13. Baseline serum creatinine (mg/dL)
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low 0.8 1.0 0.9 1.0 1.1 1.1
Middle 0.8 1.0 0.9 1.0 1.0 1.0 High 0.9 1.0 0.9 1.0 1.0 1.1 NH White Low 0.9 1.0 1.0 1.0 1.0 1.0 Middle 0.9 1.0 1.0 1.0 1.1 1.0 High 1.0 1.0 1.0 1.0 1.1 1.0 NH Black Low 1.0 1.0 1.1 1.0 1.2 1.0 Middle 1.1 1.0 1.0 1.0 1.2 1.0 High 1.1 1.0 1.1 1.0 1.2 1.0
Female Mexican Low 0.6 1.0 0.7 1.0 0.7 1.0
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
Supplementary Table 14. Baseline urine albumin creatinine ratio (mg/g)
Age
30-49 30-49 50-64 50-64 65+ 65+
Sex Race Income Mean SE Mean SE Mean SE
Male Mexican Low 7.9 1.1 8.9 1.2 22.5 1.3
Middle 7.5 1.1 9.0 1.2 21.9 1.5 High 6.0 1.1 10.8 1.2 14.5 1.4 NH White Low 6.1 1.1 11.2 1.2 12.3 1.1 Middle 5.2 1.1 8.0 1.1 11.4 1.1 High 5.3 1.0 6.6 1.1 11.3 1.1 NH Black Low 5.9 1.1 10.7 1.2 15.4 1.3 Middle 6.1 1.1 9.9 1.2 16.8 1.2 High 6.1 1.1 9.1 1.1 18.7 1.3
Female Mexican Low 11.8 1.1 11.4 1.1 16.9 1.2
Supplementary Table 15. Risk of chronic periodontitis (per 1000 person years) relative to age group (30- 44) – NHANES
. svy: logit cp ridageyr i.riagendr i.ridreth1 i.income
(running logit on estimation sample)
Survey: Logistic regression
Number of strata = 44 Number of obs = 8,519
Number of PSUs = 92 Population size = 126,836,589
Design df = 48
F( 6, 43) = 84.91
Prob > F = 0.0000
---
| Linearized
cp | Coef. Std. Err. t P>|t| [95% Conf. Interval]
---+---
ridageyr | .0362388 .0022697 15.97 0.000 .0316753 .0408023
|
riagendr |
female | -.7408982 .0491725 -15.07 0.000 -.8397662 -.6420302
|
ridreth1 |
NH White | -.9774313 .0963709 -10.14 0.000 -1.171198 -.7836647
NH Black | -.2442355 .1028459 -2.37 0.022 -.451021 -.0374499
|
incomecat |
2 | -.1619492 .0801904 -2.02 0.049 -.3231828 -.0007157
3 | -.7232604 .0739682 -9.78 0.000 -.8719834 -.5745375
|
_cons | -1.039589 .1332669 -7.80 0.000 -1.30754 -.7716375
pCP.func<- function(iage,sex,race,income){
pCP = (exp(-1.04+0.036*(iage+1) -0.74*(sex==2) -
0.98*(race==2)-0.24*(race==3)-0.16*(income==2)-0.72*(income==3))/(1+exp(-1.04+0.036*(iage+1) -0.74*(sex==2) - 0.98*(race==2)-0.24*(race==3)-0.16*(income==2)-0.72*(income==3))))-
0.98*(race==2)-0.24*(race==3)-0.16*(income==2)-0.72*(income==3))/(1+exp(-©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
1.04+0.036*iage -0.74*(sex==2) - 0.98*(race==2)-0.24*(race==3)-0.16*(income==2)-0.72*(income==3))))
pCP[is.na(pCP)]<-0
return(pCP)
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
Supplementary Table 17. Risk of type II diabetes (per 100000 person years) – CDC
Age Sex Race (Mean) (SD)
Supplementary Table 18. Model validation results
External Source
Population studied
Years of
follow-up
Outcome (and whether it was observed or
modeled from external source study)
Study result
Model result*
Hayes et al.
22UKPDS-OM2 model aged 30
or over
25
Modeled cumulative incidence of nephropathy
5.0%
6.4% (1.7)
Modeled cumulative incidence of retinopathy
11%
13.5% (2.1)
Modeled cumulative incidence of neuropathy
9.6%
12.1% (1.8)
Colhoun et al.
23Ages 40–75 in UK or Ireland
with type 2 diabetes and one
CVD risk factor but no
history of CVD
4
Observed cumulative incidence of MI
4.6%
3.9% (1.1)
Observed cumulative incidence of stroke
2.8%
2.6% (0.8)
Shah et al.
24Age 30 or above without
CVD history
5.5
Observed cumulative incidence of type 2 diabetes
2.7%
2.9% (0.9)
Gerstein et al.
25Ages 40-75 with CVD history
or Ages 55-79 with high risk
of CVD (ACCORD trial)
3.5
Observed cumulative any-cause mortality
4.0%
3.6 % (0.4)
Observed cumulative CVD morality
1.8%
1.9% (0.5)
CVD = cardiovascular disease
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
Supplementary Table 19. Quality of life and cost for disease states and treatment, mean (sd)
26-28For individuals with more than one condition, the disutility and cost were combined on additive scale. For example, individuals with type 2
diabetes and nephropathy, the quality of life would be (1-0.0061-0.103)
Disease states Quality of life (QoL) Disutility (1-QoL) Cost (per year)
Acute MI (1-2 days) 0.578 0.422
$21,842(1610)
Post MI 0.944 0.056
Stroke 0.718 0.282 $15,873 (1420)
Post CVD 0.900 0.100 $5,208 (356)
Periodontitis 0.993 0.007 See below
Tooth Loss 0.933 0.067 $2,697 (362)* Type II diabetes (w/o Periodontitis) 0.939 0.061 $2,334 (166) Nephropathy 0.896 0.104 $6,798 (500) Neuropathy 0.867 0.103 $4,000 (1,100) Retinopathy 0.916 0.084 $3,000 (780)
Periodontal scaling and root planning
CDT Description Cost
D4341 / D4342 Periodontal scaling and root
planning per quadrant $223 (65)
D4910 Periodontal maintenance $145 (30)
Total $368 (60)
Supplementary Table 20. Model parameters for probabilistic sensitivity analysis
Variable Value Distribution Source
Treatment coverage
Malaria prevalence in HIV-infected pregnant women
88% Beta(370,50) 29
Costs Treatment
Nonsurgical periodontal treatment $368 Gamma (70, 5) 28
Periodontal Maintenance $290 Gamma (25, 5.5)
Annual disease cost
Cardiovascular disease (CVD) $4,648 Gamma(2115, 2.2) 30
Post CVD $5,208 Gamma (130, 40)
Type 2 diabetes $2,334 Gamma(390,6)
Neuropathy $4,000 Gamma(8,500)
Retinopathy $3000 Gamma(12, 250)
Nephropathy $6,789 Gamma(85, 80)
Tooth loss $2,697 Gamma(67,40) 28
Disability weights
Myocardial infarction 0.422 Beta(0.73, 100) 31
Stroke 0.284 Beta(7.9,20)
Post CVD 0.1 Beta(5,40)
Type 2 diabetes 0.061 Beta(1.3, 20)
Neuropathy 0.133 Beta (4.6, 30)
Retinopathy 0.084 Beta(5.95, 65)
Nephropathy 0.104 Beta(4.65, 40)
Periodontitis 0.007 Beta(1.5, 200)
Tooth Loss 0.067 Beta(4.7, 65)
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
Supplementary Table 21. Cost-effectiveness results per capita among overall US population
Scenario
Total
QALYs
†Total
Cost (USD)
†Incremental
QALYs gained
†Incremental
Cost (USD)
†Base case
Status quo 42.71 (0.04) 28,994 (85) Expanded coverage 42.94 (0.04) 26,527 (85) 0.23 (0.01) -2,466 (34)Sensitivity analyses
Treatment coverage rate
40% 42.73 (0.04) 28,859 (86) 0.02 (0.01) - 135 (30) 60% 42.80 (0.04) 28,386 (93) 0.09 (0.01) - 608 (29) 80% 42.90 (0.04) 27,336 (93) 0.19 (0.01) -1,658 (31) 100% 43.04 (0.04) 24,308 (95) 0.33 (0.01) - 4,686 (32) Adherence rate 50% 42.74 (0.04) 28,791 (86) 0.03(0.01) -203(29) 70% 43.81 (0.04) 28,345 (86) 0.10 (0.01) -649 (28) 90% 42.89 (0.04) 27,387 (86) 0.18 (0.01) -1,607
(29)
Periodontal treatment cost*
$500 + $200/maintenance 42.94 (0.04) 27,775 (85) 0.23 (0.01) -2,194 (30) $1000 + $200/maintenance 42.94 (0.04) 28,416 (87) 0.23 (0.01) - 1,775 (28) $2000 + 200/maintenance 42.94 (0.04) 29,698 (85) 0.23 (0.01) - 936 (29) $3000 + 200/maintenance 42.94 (0.04) 30,979 (84) 0.23 (0.01) - 98 (24) $4000 + $200/maintenance 42.94 (0.04) 32,260 (85) 0.23 (0.01) 739 (29) $5000 + $200/maintenance 42.94 (0.04) 33,891 (84) 0.23 (0.01) 1,578 (30) $500 + $250/maintenance 42.94 (0.04) 28,455 (82) 0.23 (0.01) -1,998 (29) $1000 + $250/maintenance 42.94 (0.04) 29,096 (85) 0.23 (0.01) - 1,579 (28) $2000 + $250/maintenance 42.94 (0.04) 30,377 (85) 0.23 (0.01) - 740 (26) $3000 + $250/maintenance 42.94 (0.04) 31,659 (85) 0.23 (0.01) 97 (25) $4000 + $250/maintenance 42.94 (0.04) 32,940 (84) 0.23 (0.01) 935 (29) $5000 + $250/maintenance 42.94 (0.04) 34,222 (84) 0.23 (0.01) 1,774 (30)
Treatment benefits
‡HbA1c reduction (0.6%)
among poorly controlled
42.95 (0.04)
26,521 (86)
0.24 (0.02)
-2,473 (30)
Without benefits on CVD
42.92 (0.04)
26,617 (83)
0.21 (0.01)
-2,377 (29)
Without benefits on
neuropathy
§42.89 (0.04)
26,655 (82)
0.18 (0.01)
-2,139 (40)
Without benefits on CVDs
and neuropathy
§42.85 (0.04)
46,361 (83)
0.15 (0.01)
-2,263 (39)
*Results includes individuals who were not diagnosed with T2D at the beginning of the simulation.
† Per-person results over their lifetime, discounted using a 3% annual rate ‡ Total cost (and total QALYs when assuming no effects of treatment on CVD outcomes) in the status quo scenario is different from the total cost (and total QALYs when CVD is excluded) in the base case status quo scenario due to varying treatment costs
§
©2019 American Diabetes Association. Published online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc19-1201/-/DC1
