title: An evaluation of cost sharing to finance a diet and physical activity intervention to prevent diabetes.
abstract: OBJECTIVE
  The Diabetes Prevention Program (DPP) lifestyle intervention is a cost-effective strategy to prevent type 2 diabetes, but it is unclear how this intervention could be financed. We explored whether this intervention could be offered in a way that allows return on investment for private health insurers while remaining attractive for consumers, employers, and Medicare.
  
  
  METHODS
  We used the DPP and other published reports to build a Markov simulation model to estimate the lifetime progression of disease, costs, and quality of life for adults with impaired glucose tolerance. The model assumed a health-payer perspective and compared DPP lifestyle and placebo interventions. Primary outcomes included cumulative incidence of diabetes, direct medical costs, quality-adjusted life-years (QALYs), and cost per QALY gained.
  
  
  RESULTS
  Compared with placebo, providing the lifestyle intervention at age 50 years could prevent 37% of new cases of diabetes before age 65, at a cost of $1,288 per QALY gained. A private payer could reimburse $655 (24%) of the $2,715 in total discounted intervention costs during the first 3 intervention years and still recover all of these costs in the form of medical costs avoided. If Medicare paid up to $2,136 in intervention costs over the 15-year period before participants reached age 65, it could recover those costs in the form of future medical costs avoided beginning at age 65.
  
  
  CONCLUSIONS
  Cost-sharing strategies to offer the DPP lifestyle intervention for eligible people between ages 50 and 64 could provide financial return on investment for private payers and long-term benefits for Medicare.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, 250 University Blvd., Suite 122, Indianapolis, IN 46202, USA. rtackerm@iupui.edu
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Ackermann
authors.forename: David G
authors.initials: DG
authors.lastname: Marrero
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Hicks
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hoerger
authors.forename: Stephen
authors.initials: S
authors.lastname: Sorensen
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.forename: Michael M
authors.initials: MM
authors.lastname: Engelgau
authors.forename: Robert E
authors.initials: RE
authors.lastname: Ratner
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
mesh_terms: D000368:Aged; D017047:Cost Sharing; D003920:Diabetes Mellitus / Q000191:economics* / Q000517:prevention & control*; D004032:Diet / Q000191:economics*; D018450:Disease Progression; D015444:Exercise; D018149:Glucose Intolerance / Q000191:economics; D006304:Health Status; D006801:Humans; D008019:Life Style; D006278:Medicare; D008875:Middle Aged; D011336:Probability; D014481:United States