Cost-effectiveness of lifestyle modification in diabetic patients.
OBJECTIVE To explore the potential long-term health and economic consequences of lifestyle interventions for diabetic patients. RESEARCH DESIGN AND METHODS A literature search was performed to identify interventions for diabetic patients in which lifestyle issues were addressed. We selected recent (2003-2008), randomized controlled trials with a minimum follow-up of 12 months. The long-term outcomes for these interventions, if implemented in the Dutch diabetic population, were simulated with a computer-based model. Costs and effects were discounted at, respectively, 4 and 1.5% annually. A lifelong time horizon was applied. Probabilistic sensitivity analyses were performed, taking account of variability in intervention costs and (long-term) treatment effects. RESULTS Seven trials with 147-5,145 participants met our predefined criteria. All interventions improved cardiovascular risk factors at > or =1 year follow-up and were projected to reduce cardiovascular morbidity over lifetime. The interventions resulted in an average gain of 0.01-0.14 quality-adjusted life-years (QALYs) per participant. Health benefits were generally achieved at reasonable costs (< or =euro50,000/QALY). A self-management education program (X-PERT) and physical activity counseling achieved the best results with > or =0.10 QALYs gained and > or =99% probability to be very cost-effective (< or =euro20,000/QALY). CONCLUSIONS Implementation of lifestyle interventions would probably yield important health benefits at reasonable costs. However, essential evidence for long-term maintenance of health benefits was limited. Future research should be focused on long-term effectiveness and multiple treatment strategies should be compared to determine incremental costs and benefits of one over the other.
Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands. monique.jacobs@rivm.nl
Monique A M
MA
Jacobs-van der Bruggen
Pieter H
PH
van Baal
Rudolf T
RT
Hoogenveen
Talitha L
TL
Feenstra
Andrew H
AH
Briggs
Kenny
K
Lawson
Edith J M
EJ
Feskens
Caroline A
CA
Baan
D001521:Behavior Therapy / Q000191:economics*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000191:economics / Q000523:psychology* / Q000534:rehabilitation; D005060:Europe; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008954:Models, Biological; D010353:Patient Education as Topic; D012648:Self Care