title: The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS.
abstract: OBJECTIVE
  The Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) demonstrated that either intensive lifestyle intervention or metformin could prevent type 2 diabetes in high-risk adults for at least 10 years after randomization. We report the 10-year within-trial cost-effectiveness of the interventions.
  
  
  METHODS
  Data on resource utilization, cost, and quality of life were collected prospectively. Economic analyses were performed from health system and societal perspectives.
  
  
  RESULTS
  Over 10 years, the cumulative, undiscounted per capita direct medical costs of the interventions, as implemented during the DPP, were greater for lifestyle ($4,601) than metformin ($2,300) or placebo ($769). The cumulative direct medical costs of care outside the DPP/DPPOS were least for lifestyle ($24,563 lifestyle vs. $25,616 metformin vs. $27,468 placebo). The cumulative, combined total direct medical costs were greatest for lifestyle and least for metformin ($29,164 lifestyle vs. $27,915 metformin vs. $28,236 placebo). The cumulative quality-adjusted life-years (QALYs) accrued over 10 years were greater for lifestyle (6.81) than metformin (6.69) or placebo (6.67). When costs and outcomes were discounted at 3%, lifestyle cost $10,037 per QALY, and metformin had slightly lower costs and nearly the same QALYs as placebo.
  
  
  CONCLUSIONS
  Over 10 years, from a payer perspective, lifestyle was cost-effective and metformin was marginally cost-saving compared with placebo. Investment in lifestyle and metformin interventions for diabetes prevention in high-risk adults provides good value for the money spent.
authors.affiliation: Diabetes Prevention Program Coordinating Center. dppmail@biostat.bsc.gwu.edu
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D057194:Intention to Treat Analysis; D008297:Male; D008687:Metformin / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D011236:Prediabetic State / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic / Q000191:economics; D040242:Risk Reduction Behavior; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin