title: A cost-effectiveness analysis of a community-based diabetes prevention program in Sweden.
abstract: OBJECTIVE
  Lifestyle changes to prevent type 2 diabetes among high-risk persons have been shown to be cost-effective. This study investigates the cost-effectiveness of a community-based program promoting general population lifestyle changes to prevent diabetes.
  
  
  METHODS
  The 10-year program was implemented in three municipalities in Sweden. Effectiveness was measured with a quasiexperimental cohort design, that is, risk factor levels in a population group aged 36-56 years at baseline and 8-10 years later (2,149 men; 3,092 women) in the program municipalities and a control area were compared. The incremental cost-utility analysis included future diabetes and cardiovascular disease-related health effects and societal costs (discounted 3 percent), estimated by a Markov model.
  
  
  RESULTS
  In all areas, risk factor levels increased during follow-up, leading to increased societal costs of between SEK40,000 and 90,000 (1 Euro 2004 = SEK9.13; 1 US$ = SEK 7.35) and quality-adjusted life-year (QALY) losses between 0.12 and 0.48 per individual. Compared with the control area, the cost increases and QALY losses for women were more favorable in two program areas but less favorable in one, and less favorable for men in both areas (data unavailable for one municipality). The findings indicate that the program was cost-effective in only two female study groups.
  
  
  CONCLUSIONS
  Conflicting results on the cost-effectiveness of the program were obtained. As several potentially valuable aspects of the program are not included in the cost-effectiveness analysis, the societal value of the program might not be adequately reflected.
authors.affiliation: Karolinska Institutet, Stockholm, Sweden. pia.johansson@ki.se
authors.forename: Pia
authors.initials: P
authors.lastname: Johansson
authors.forename: Claes-Göran
authors.initials: CG
authors.lastname: Ostenson
authors.forename: Agneta M
authors.initials: AM
authors.lastname: Hilding
authors.forename: Camilla
authors.initials: C
authors.lastname: Andersson
authors.forename: Clas
authors.initials: C
authors.lastname: Rehnberg
authors.forename: Per
authors.initials: P
authors.lastname: Tillgren
mesh_terms: D000328:Adult; D019058:Community Networks; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000191:economics*; D015397:Program Evaluation / Q000191:economics*; D040242:Risk Reduction Behavior; D013548:Sweden