title: Costs associated with the primary prevention of type 2 diabetes mellitus in the diabetes prevention program.
abstract: OBJECTIVE
  To describe the costs of the Diabetes Prevention Program (DPP) interventions to prevent or delay type 2 diabetes.
  
  
  METHODS
  We describe the direct medical costs, direct nonmedical costs, and indirect costs of the placebo, metformin, and intensive lifestyle interventions over the 3-year study period of the DPP. Resource use and cost are summarized from the perspective of a large health system and society. Research costs are excluded.
  
  
  RESULTS
  The direct medical cost of laboratory tests to identify one subject with impaired glucose tolerance (IGT) was $139. Over 3 years, the direct medical costs of the interventions were $79 per participant in the placebo group, $2,542 in the metformin group, and $2,780 in the lifestyle group. The direct medical costs of care outside the DPP were $272 less per participant in the metformin group and $432 less in the lifestyle group compared with the placebo group. Direct nonmedical costs were $9 less per participant in the metformin group and $1,445 greater in the lifestyle group compared with the placebo group. Indirect costs were $230 greater per participant in the metformin group and $174 less in the lifestyle group compared with the placebo group. From the perspective of a health system, the cost of the metformin intervention relative to the placebo intervention was $2,191 per participant and the cost of the lifestyle intervention was $2,269 per participant over 3 years. From the perspective of society, the cost of the metformin intervention relative to the placebo intervention was $2,412 per participant and the cost of the lifestyle intervention was $3,540 per participant over 3 years.
  
  
  CONCLUSIONS
  The metformin and lifestyle interventions are associated with modest incremental costs compared with the placebo intervention. The evaluation of costs relative to health benefits will determine the value of these interventions to health systems and society.
authors.affiliation: The Diabetes Prevention Program Coordinating Center, Biostatistics Center, George Washington University, Rockville, Maryland 20852, USA. dppmail@biostat.bsc.gwu.edu
authors.forename: William H
authors.initials: WH
authors.lastname: Hernan
authors.forename: Michael
authors.initials: M
authors.lastname: Brandle
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.forename: David F
authors.initials: DF
authors.lastname: Williamson
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Matulik
authors.forename: Robert E
authors.initials: RE
authors.lastname: Ratner
authors.forename: John M
authors.initials: JM
authors.lastname: Lachin
authors.forename: Michael M
authors.initials: MM
authors.lastname: Engelgau
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics* / Q000517:prevention & control*; D004180:Direct Service Costs; D016903:Drug Monitoring; D005102:Health Expenditures; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics; D008687:Metformin / Q000008:administration & dosage / Q000191:economics; D011314:Preventive Health Services / Q000191:economics*; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin