Cost-effectiveness analysis of efforts to reduce risk of type 2 diabetes and cardiovascular disease in southwestern Pennsylvania, 2005-2007.
BACKGROUND
We assessed the cost-effectiveness of a community-based, modified Diabetes Prevention Program (DPP) designed to reduce risk factors for type 2 diabetes and cardiovascular disease.


METHODS
We developed a Markov decision model to compare costs and effectiveness of a modified DPP intervention with usual care during a 3-year period. Input parameters included costs and outcomes from 2 projects that implemented a community-based modified DPP for participants with metabolic syndrome, and from other sources. The model discounted future costs and benefits by 3% annually.


RESULTS
At 12 months, usual care reduced relative risk of metabolic syndrome by 12.1%. A modified DPP intervention reduced relative risk by 16.2% and yielded life expectancy gains of 0.01 quality-adjusted life-years (3.67 days) at an incremental cost of $34.50 ($3,420 per quality-adjusted life-year gained). In 1-way sensitivity analyses, results were sensitive to probabilities that risk factors would be reduced with or without a modified DPP and that patients would enroll in an intervention, undergo testing, and acquire diabetes with or without an intervention if they were risk-factor-positive. Results were also sensitive to utilities for risk-factor-positive patients. In probabilistic sensitivity analysis, the intervention cost less than $20,000 per quality-adjusted life-year gained in approximately 78% of model iterations.


CONCLUSIONS
We consider the modified DPP delivered in community and primary care settings a sound investment.
Smith
Kenneth J
KJ
University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Hsu
Heather E
HE
Roberts
Mark S
MS
Kramer
M Kaye
MK
Orchard
Trevor J
TJ
Piatt
Gretchen A
GA
Seidel
Miriam C
MC
Zgibor
Janice C
JC
Bryce
Cindy L
CL
D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003153:Community Health Services; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control*; D004032:Diet; D006801:Humans; D008019:Life Style; D008390:Markov Chains; D010414:Pennsylvania / Q000453:epidemiology; D012680:Sensitivity and Specificity; D013997:Time Factors