Display Settings:

Format

Send to:

Choose Destination
We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Ann Intern Med. 2005 Mar 1;142(5):323-32.

The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance.

Author information

  • 1University of Michigan Health System, Ann Arbor, Michigan, USA.

Abstract

BACKGROUND:

The Diabetes Prevention Program (DPP) demonstrated that interventions can delay or prevent the development of type 2 diabetes.

OBJECTIVE:

To estimate the lifetime cost-utility of the DPP interventions.

DESIGN:

Markov simulation model to estimate progression of disease, costs, and quality of life.

DATA SOURCES:

The DPP and published reports.

TARGET POPULATION:

Members of the DPP cohort 25 years of age or older with impaired glucose tolerance.

TIME HORIZON:

Lifetime.

PERSPECTIVES:

Health system and societal.

INTERVENTIONS:

Intensive lifestyle, metformin, and placebo interventions as implemented in the DPP.

OUTCOME MEASURES:

Cumulative incidence of diabetes, microvascular and neuropathic complications, cardiovascular complications, survival, direct medical and direct nonmedical costs, quality-adjusted life-years (QALYs), and cost per QALY.

RESULTS OF BASE-CASE ANALYSIS:

Compared with the placebo intervention, the lifestyle and metformin interventions were estimated to delay the development of type 2 diabetes by 11 and 3 years, respectively, and to reduce the absolute incidence of diabetes by 20% and 8%, respectively. The cumulative incidence of microvascular, neuropathic, and cardiovascular complications were reduced and survival was improved by 0.5 and 0.2 years. Compared with the placebo intervention, the cost per QALY was approximately 1100 dollars for the lifestyle intervention and $31 300 for the metformin intervention. From a societal perspective, the interventions cost approximately 8800 dollars and 29,900 dollars per QALY, respectively. From both perspectives, the lifestyle intervention dominated the metformin intervention.

RESULTS OF SENSITIVITY ANALYSIS:

Cost-effectiveness improved when the interventions were implemented as they might be in routine clinical practice. The lifestyle intervention was cost-effective in all age groups. The metformin intervention did not represent good use of resources for persons older than 65 years of age.

LIMITATIONS:

Simulation results depend on the accuracy of the underlying assumptions, including participant adherence.

CONCLUSIONS:

Health policy should promote diabetes prevention in high-risk individuals.

Comment in

PMID:
15738451
[PubMed - indexed for MEDLINE]
PMCID:
PMC2701392
Free PMC Article

Images from this publication.See all images (1)Free text

Figure
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems Icon for PubMed Central
    Loading ...
    Write to the Help Desk