Within-Trial Cost-Effectiveness of Lifestyle Intervention or Metformin for the Primary Prevention of Type 2 Diabetes

Abstract

OBJECTIVE-The Diabetes PreventionProgram (DPP) demonstrated that intensive lifestyle and metformin interventions reduced the incidence of type 2 diabetes compared with a placebo intervention. The aim of this study was to assess the cost-effectiveness of the lifestyle and metformin interventions relative to the placebo intervention.RESEARCH DESIGN AND METHODS-Analyses were performed from a health system perspective that considered direct medical costs only and a societal perspective that considered direct medical costs, direct nonmedical costs, and indirect costs. Analyses were performed with the interventions as implemented in the DPP and as they might be implemented in clinical practice. RESULTS-The lifestyle and metformin interventions required more resources than the placebo intervention from a health system perspective, and over 3 years they cost approximately $2,250 more per participant. As implemented in the DPP and from a societal perspective, the lifestyle and metformin interventions cost $24,400 and $34,500, respectively, per case of diabetes delayed or prevented and $51,600 and $99,200 per quality-adjusted life-year (QALY) gained. As the interventions might be implemented in routine clinical practice and from a societal perspective, the lifestyle and metformin interventions cost $13,200 and $14,300, respectively, per case of diabetes delayed or prevented and $27,100 and $35,000 per QALY gained. From a health system perspective, costs per case of diabetes delayed or prevented and costs per QALY gained tended to be lower. CONCLUSIONS-Over 3 years, the lifestyle and metformin interventions were effective and were cost-effective from the perspective of a health system and society. Both interventions are likely to be affordable in routine clinical practice, especially if implemented in a group format and with generic medication pricing.Intensive lifestyle and medication interventions can delay or prevent progression from impaired glucose tolerance (IGT) to type 2 diabetes (1-3). The Diabetes Prevention Program (DPP) demonstrated that compared with the placebo intervention, the intensive lifestyle intervention reduced the incidence of type 2 diabetes by 58%, and the metformin intervention reduced the incidence of type 2 diabetes by 31% over 2.8 years (3).

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

“…Of these, 6 cost-only studies (20–23, 26, 27) and 6 cost-effectiveness studies (19, 24, 25, 28–30) provided information on the actual cost of diet and physical activity promotion programs, and 22 contributed cost-effectiveness estimates of the programs (19, 24, 25, 28–46). Fourteen studies were U.S.-based (19–24, 26, 27, 31, 35–38, 46). No cost–benefit studies were identified.…”

“…Of the 12 studies that reported the actual costs of implementing the program (20–31), only 4 included costs for identifying persons at increased risk (22, 24, 27, 29). The major cost driver was staff time to deliver the intervention.…”

“…Of 22 studies reporting the cost-effectiveness of the programs, 8 were U.S.-based (19, 24, 31, 35–38, 46). Seventeen studies reported the outcome measure as cost per QALY saved (19, 24, 25, 28–31, 35–40, 42– 44, 46), 6 reported cost per LYG (32–34, 39, 40, 43), and 2 reported cost per DALY averted (41, 45).…”

“…All studies except 1 (42) reported ICERs from a health system perspective. Eight studies (19, 28, 31, 36, 38, 39, 42, 44) reported ICERs from a societal perspective, and 7 (19, 28, 31, 36, 38, 39, 44) reported both health system and societal perspectives. However, only 1 study included all of the costs and benefits from society as a whole (44).…”

Research aimed at improving both mood and weight (RAINBOW) in primary care: A type 1 hybrid design randomized controlled trial

“…Intervention start-up costs, fixed costs of sustaining the intervention, and marginal costs of adding additional participants to the intervention will be differentiated because they are relevant for different decisions: whether to implement the intervention in the first place and whether to sustain or expand it over time. We will use simulation models, similar to those in Diabetes Prevention Program and Sequenced Treatment Alternatives to Relieve Depression, 68,73,74 to analyze incremental cost-effectiveness ratios during the trial and projected into 5-, 10-, 20-, 30-year, and lifetime horizons. Cost-utility estimates with different time horizons will be useful for stakeholders deciding on program implementation.…”