The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance.
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.
Herman
William H
WH
University of Michigan Health System, Ann Arbor, Michigan, USA.
Hoerger
Thomas J
TJ
Brandle
Michael
M
Hicks
Katherine
K
Sorensen
Stephen
S
Zhang
Ping
P
Hamman
Richard F
RF
Ackermann
Ronald T
RT
Engelgau
Michael M
MM
Ratner
Robert E
RE
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
D007004:Hypoglycemic Agents; D008687:Metformin
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