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.
Jacobs-van der Bruggen
Monique A M
MA
Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands. monique.jacobs@rivm.nl
van Baal
Pieter H
PH
Hoogenveen
Rudolf T
RT
Feenstra
Talitha L
TL
Briggs
Andrew H
AH
Lawson
Kenny
K
Feskens
Edith J M
EJ
Baan
Caroline A
CA
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