Economic Evaluation of Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force

Abstract

Background Diabetes is a highly prevalent and costly disease. Studies indicate that combined diet and physical activity promotion programs can prevent type 2 diabetes among persons at increased risk. Purpose To systematically evaluate the evidence on cost, cost-effectiveness, and cost-benefit estimates of diet and physical activity promotion programs. Data Sources Cochrane Library, EMBASE, MEDLINE, PsycINFO, Sociological Abstracts, Web of Science, EconLit, and CINAHL through 7 April 2015. Study Selection English-language studies from high-income countries that provided data on cost, cost-effectiveness, or cost-benefit ratios of diet and physical activity promotion programs with at least 2 sessions over at least 3 months delivered to persons at increased risk for type 2 diabetes. Data Extraction Dual abstraction and assessment of relevant study details. Data Synthesis Twenty-eight studies were included. Costs were expressed in 2013 U.S. dollars. The median program cost per participant was $653. Costs were lower for group-based programs (median, $417) and programs implemented in community or primary care settings (median, $424) than for the U.S. DPP (Diabetes Prevention Program) trial and the DPP Outcomes Study ($5881). Twenty-two studies assessed the incremental cost-effectiveness ratios (ICERs) of the programs. From a health system perspective, 16 studies reported a median ICER of $13 761 per quality-adjusted life-year (QALY) saved. Group-based programs were more cost-effective (median, $1819 per QALY) than those that used individual sessions (median, $15 846 per QALY). No cost-benefit studies were identified. Limitation Information on recruitment costs and cost-effectiveness of translational programs implemented in community and primary care settings was limited. Conclusion Diet and physical activity promotion programs to prevent type 2 diabetes are cost-effective among persons at increased risk. Costs are lower when programs are delivered to groups in community or primary care settings. Primary Funding Source None.

Cost-effectiveness of the 2014 U.S. Preventive Services Task Force (USPSTF) Recommendations for Intensive Behavioral Counseling Interventions for Adults With Cardiovascular Risk Factors

“…Our results are consistent with those of previous studies that found intensive lifestyle interventions aimed at reducing the incidence of type 2 diabetes among people with prediabetes to be cost effective, with a median cost of approximately $14,000/QALY gained (15). Our risk group analysis was also consistent with a previous study (30) of diabetes prevention interventions, in which those with higher levels of fasting plasma glucose or A1C had more favorable CE ratios than those at the lower end of the prediabetes spectrum.…”

“…For cost, we examined two scenarios: implementing the recommended intervention only in a group-based setting; and adding the cost of screening to identify those eligible for intervention. Group-based interventions generally have lower costs and results that are comparable to those of individual-based interventions (15). In the screening test scenario, we assumed a medical visit with a lipid panel test and fasting plasma glucose test were needed to identify high-risk individuals, with costs derived from the Medicare Physician Fee Schedule 2014 (28).…”

“…Because the USPSTF review did not report the cost of interventions, we specified our cost assumptions based on a recent review of 28 similar behavioral interventions (15). The median intervention cost per participant was $653, which represented an intervention with a mixture of group and individual sessions.…”

High Fasting Plasma Glucose, Diabetes, and Its Risk Factors in the Eastern Mediterranean Region, 1990–2013: Findings From the Global Burden of Disease Study 2013

“…Increasing the entire population's awareness has an important role in most of the interventions. Primary prevention at the community level, as well as primary health care interventions, are usually the most cost-effective programs to prevent and reduce the burden of diabetes (38,39). There is a wide range of available resources and health care expenditure for individuals with diabetes in the region (7).…”

“Prediabetes”: Are There Problems With This Label? Yes, the Label Creates Further Problems!

“…Diabetes health care needs and costs are likely to be dependent upon the duration of the condition and its severity and so are unlikely to differ greatly between the patient with newly diagnosed diabetes and someone with "prediabetes." The problem of treating "prediabetes" and diabetes as transition statesdseparate categories, each with its own disutility and costdalso applies to many of the modeling studies summarized in the CPSTF report (22), with the notable exception of those from the DPP. If someone is considered in a mathematical model as having developed diabetes and is thus assumed to share the average health disutility (23) and the annual costs (24) assessed for a population with diabetes, this may exaggerate the apparent benefits of prevention.…”