Assessing the cost-effectiveness of drug and lifestyle intervention following opportunistic screening for pre-diabetes in primary care

Abstract

Aims/hypothesis This study aims to evaluate the costeffectiveness of a screening programme for pre-diabetes, which was followed up by treatment with pharmaceutical interventions (acarbose, metformin, orlistat) or lifestyle interventions (diet, exercise, diet and exercise) in order to prevent or slow the onset of diabetes in those at high risk. Methods To approximate the experience of individuals with pre-diabetes in the Australian population, we used a microsimulation approach, following patient progression through diabetes, cardiovascular disease and renal failure. The model compares costs and disability-adjusted life years lived in people identified through an opportunistic screening programme for each intervention compared with a 'do nothing' scenario, which is representative of current practice. It is assumed that the effect of a lifestyle change will decay by 10% per year, while the effect of a pharmaceutical intervention remains constant throughout use. Results The most cost-effective intervention options are diet and exercise combined, with a cost-effectiveness ratio of AUD 22,500 per disability-adjusted life year (DALY) averted, and metformin with a cost-effectiveness ratio of AUD 21,500 per DALY averted. The incremental addition of one intervention to the other is not cost-effective. Conclusions/interpretation Screening for pre-diabetes followed by diet and exercise, or metformin treatment is costeffective and should be considered for incorporation into current practice. The number of dietitians and exercise physiologists needed to deliver such lifestyle change interventions will need to be increased to appropriately support the intervention.

Value of Primordial and Primary Prevention for Cardiovascular Disease

“…185 Other cost-effectiveness analyses outside the United States have also found both drug and lifestyle interventions to be cost-effective, although it is difficult to extrapolate those results to the United States because healthcare and reimbursement systems vary significantly. 184,186 Mathematical models evaluating the cost-effectiveness of community-based diabetes mellitus prevention programs using lifestyle interventions show conflicting results. A community-based modified Diabetes Prevention Program intervention designed to reduce risk factors for T2DM decreased metabolic syndrome risk by 16.2% at 12 months compared with 12.1% for usual care at an increased cost of $3420 per QALY gained.…”

Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys

“…1 Previous studies have documented significant deficits in the management of individuals with diabetes. [3][4][5][6][7][8] Five strategies can help reduce the burden of diabetes at the population level: (i) case prevention through reductions in modifiable risk factors such as obesity; (ii) screening coupled with pharmacological or lifestyle interventions targeting individuals with pre-diabetes; 9,10 (iii) improved diagnosis and control of blood glucose among individuals with diabetes; [11][12][13] (iv) improved management of microvascular complications, including renal disease, retinopathy, diabetic foot and other neuropathies; 14,15 and (v) improved management of associated cardiovascular risks. 13,16 It is essential to understand how well health systems are performing in terms of these five strategies and the role of health system and individual attributes such as physical access, financial access, provider quality and patient education and motivation.…”

The Michigan Model for Coronary Heart Disease in Type 2 Diabetes: Development and Validation

“…To our knowledge, none of the published, diabetes diseasestate simulation models, [20][21][22][23][24][25][26][27][28][29][30][31][32][33] including the recently published UKPDS Outcomes Model 2, 34 takes into account currently available medical and surgical treatments. For the general population, various CHD policy models exist.…”