title: The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance.
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.
  
  
  METHODS
  Markov simulation model to estimate progression of disease, costs, and quality of life.
  
  
  METHODS
  The DPP and published reports.
  
  
  METHODS
  Members of the DPP cohort 25 years of age or older with impaired glucose tolerance.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Health system and societal.
  
  
  METHODS
  Intensive lifestyle, metformin, and placebo interventions as implemented in the DPP.
  
  
  METHODS
  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
  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
  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.
  
  
  CONCLUSIONS
  Simulation results depend on the accuracy of the underlying assumptions, including participant adherence.
  
  
  CONCLUSIONS
  Health policy should promote diabetes prevention in high-risk individuals.
authors.affiliation: University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hoerger
authors.forename: Michael
authors.initials: M
authors.lastname: Brandle
authors.forename: Katherine
authors.initials: K
authors.lastname: Hicks
authors.forename: Stephen
authors.initials: S
authors.lastname: Sorensen
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.forename: Richard F
authors.initials: RF
authors.lastname: Hamman
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Ackermann
authors.forename: Michael M
authors.initials: MM
authors.lastname: Engelgau
authors.forename: Robert E
authors.initials: RE
authors.lastname: Ratner
mesh_terms: D000328:Adult; D000368:Aged; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics* / Q000517:prevention & control*; D004038:Diet, Reducing; D018450:Disease Progression; D015444:Exercise; D018149:Glucose Intolerance / Q000150:complications* / Q000191:economics; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D008019:Life Style; D008390:Markov Chains; D008687:Metformin / Q000191:economics* / Q000627:therapeutic use; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
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