title: Achievable cost saving and cost-effective thresholds for diabetes prevention lifestyle interventions in people aged 65 years and older: a single-payer perspective.
abstract: BACKGROUND
  More than 75% of people older than 65 years of age in the United States have prediabetes or diabetes. Diabetes is a burden on Medicare, the US health care payer. Intensive lifestyle interventions have successfully prevented diabetes cases, and medical nutrition therapy has also significantly reduced diabetes risk factors. Including medical nutrition therapy coverage for prediabetes is a policy decision to be made by Medicare, and cost-effectiveness data must support that decision.
  
  
  OBJECTIVE
  The aims of this study were to determine the thresholds of diabetes cases that need to be averted by prediabetes lifestyle interventions in order to be cost saving and/or cost-effective to a single health care insurance payer, such as Medicare; and to compare those thresholds with published intervention data to determine the feasibility of cost savings and/or cost-effectiveness.
  
  
  METHODS
  This analysis used standard methods of cost-effectiveness and cost saving analysis. A health system perspective was used. Cost estimates for diabetes treatment and lifestyle interventions were based on published data. Costs for 3-, 6-, and 10-year lifestyle interventions were calculated. Sensitivity analyses were performed using least and most-conservative published data for health care and intervention costs.
  
  
  RESULTS
  The number of cases averted needed for base-case cost savings ranged from 882,883 to 2,443,686, and in sensitivity analysis from 394,148 to 6,738,678. Cost savings are likely in the base and least-conservative scenarios. The number of cases averted needed for base-case cost-effectiveness ranged from 454,755 to 1,258,692, and in sensitivity analysis from 212,225 to 4,843,262. Cost-effectiveness is likely in all interventions, except the 10-year interventions in the most-conservative scenario.
  
  
  CONCLUSIONS
  Prediabetes lifestyle interventions for people aged 65 years or older are highly cost-effective and possibly cost saving to a health care insurance payer such as Medicare. It is likely that medical nutrition therapy could be even more cost saving and/or cost-effective than intensive lifestyle interventions. These results suggest that Medicare would receive financial benefit from providing coverage for these services.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, International Health, Human Nutrition Department, Baltimore, MD, USA. jmanderson1854@gmail.com
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Anderson
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D048909:Diabetes Complications / Q000191:economics / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000517:prevention & control*; D005260:Female; D017048:Health Care Costs; D018166:Health Care Reform; D006801:Humans; D008019:Life Style; D008297:Male; D006278:Medicare / Q000191:economics*; D044623:Nutrition Therapy / Q000191:economics* / Q000592:standards; D017063:Outcome Assessment, Health Care; D011236:Prediabetic State / Q000191:economics / Q000517:prevention & control; D040242:Risk Reduction Behavior; D012680:Sensitivity and Specificity; D018855:Single-Payer System / Q000191:economics*; D014481:United States