Cost-effectiveness of Diabetes Prevention Interventions Targeting High-risk Individuals and Whole Populations: A Systematic Review

Abstract

OBJECTIVE We conducted a systematic review of studies evaluating the cost-effectiveness (CE) of interventions to prevent type 2 diabetes (T2D) among high-risk individuals and whole populations. RESEARCH DESIGN AND METHODS Interventions targeting high-risk individuals are those that identify people at high risk of developing T2D and then treat them with either lifestyle or metformin interventions. Population-based prevention strategies are those that focus on the whole population regardless of the level of risk, creating public health impact through policy implementation, campaigns, and other environmental strategies. We systematically searched seven electronic databases for studies published in English between 2008 and 2017. We grouped lifestyle interventions targeting high-risk individuals by delivery method and personnel type. We used the median incremental cost-effectiveness ratio (ICER), measured in cost per quality-adjusted life year (QALY) or cost saved to measure the CE of interventions. We used the $50,000/QALY threshold to determine whether an intervention was cost-effective or not. ICERs are reported in 2017 U.S. dollars. RESULTS Our review included 39 studies: 28 on interventions targeting high-risk individuals and 11 targeting whole populations. Both lifestyle and metformin interventions in high-risk individuals were cost-effective from a health care system or a societal perspective, with median ICERs of $12,510/QALY and $17,089/QALY, respectively, compared with no intervention. Among lifestyle interventions, those that followed a Diabetes Prevention Program (DPP) curriculum had a median ICER of $6,212/QALY, while those that did not follow a DPP curriculum had a median ICER of $13,228/QALY. Compared with lifestyle interventions delivered one-on-one or by a health professional, those offered in a group setting or provided by a combination of health professionals and lay health workers had lower ICERs. Among population-based interventions, taxing sugar-sweetened beverages was cost-saving from both the health care system and governmental perspectives. Evaluations of other population-based interventions—including fruit and vegetable subsidies, community-based education programs, and modifications to the built environment—showed inconsistent results. CONCLUSIONS Most of the T2D prevention interventions included in our review were found to be either cost-effective or cost-saving. Our findings may help decision makers set priorities and allocate resources for T2D prevention in real-world settings.

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2021

“…After 5.3 years of follow-up, CVD risk factors were modestly but significantly improved with intensive treatment compared with routine care, but the incidence of first CVD events or mortality was not significantly different between the groups (59). The screening has been reinforced in cohort studies (81,82). Additional considerations regarding testing for type 2 diabetes and prediabetes in asymptomatic patients include the following.…”

Estimated number of eligible Part B beneficiaries for the medicare diabetes prevention program at the county level and by urban–rural classification

“…Moin and colleagues examined results from a trial of an online DPP found that an online DPP intervention achieved a similar weight loss goal compared to in-person DPP [ 19 ]. However, more research is needed to better understand the effectiveness and cost-effectiveness of virtual/on-line programs [ 20 ].…”

Analysis of Influencing Factors of Community Management of Diabetes Based on Adaptive-Lasso Logistic Regression Model: A Community-based Study

“…Community-based diabetes management has become a cost-effective and cost-saving strategy for controlling and managing diabetes in primary care settings. [2][3][4] The community-based intervention positively reduced the HbA1c level of diabetic people and improved lipids and blood pressure control [5][6][7][8] . In primary care and community settings, interventions targeting diabetes management were better targeted at individuals with poor glycemic control, old age, and family history of diabetes and cardiovascular diseases [9][10] .…”