title: The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program.
abstract: BACKGROUND
  Policymakers need to know the cost-effectiveness of interventions to prevent type 2 diabetes (T2D). The objective of this study was to estimate the cost-effectiveness of a T2D prevention initiative targeting weight reduction, increased physical activity and healthier diet in persons in pre-diabetic states by comparing a hypothetical intervention versus no intervention in a Swedish setting.
  
  
  METHODS
  A Markov model was used to study the cost-effectiveness of a T2D prevention program based on lifestyle change versus a control group where no prevention was applied. Analyses were done deterministically and probabilistically based on Monte Carlo simulation for six different scenarios defined by sex and age groups (30, 50, 70 years). Cost and quality adjusted life year (QALY) differences between no intervention and intervention and incremental cost-effectiveness ratios (ICERs) were estimated and visualized in cost-effectiveness planes (CE planes) and cost-effectiveness acceptability curves (CEA curves).
  
  
  RESULTS
  All ICERs were cost-effective and ranged from 3833 €/QALY gained (women, 30 years) to 9215 €/QALY gained (men, 70 years). The CEA curves showed that the probability of the intervention being cost-effective at the threshold value of 50,000 € per QALY gained was very high for all scenarios ranging from 85.0 to 91.1%.
  
  
  CONCLUSIONS
  The prevention or the delay of the onset of T2D is feasible and cost-effective. A small investment in healthy lifestyle with change in physical activity and diet together with weight loss are very likely to be cost-effective.
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden. Anne.Neumann@uniklinikum-dresden.de.|Center of Evidence-Based Healthcare, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. Anne.Neumann@uniklinikum-dresden.de.
authors.forename: Anne
authors.identifier: http://orcid.org/0000-0003-0796-7575
authors.initials: A
authors.lastname: Neumann
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Lindholm
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Norberg
authors.affiliation: Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Schoffer
authors.affiliation: Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors.forename: Stefanie J
authors.initials: SJ
authors.lastname: Klug
authors.affiliation: Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Norström
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D000072001:Diet, Healthy; D015444:Exercise; D005260:Female; D006293:Health Promotion / Q000191:economics / Q000458:organization & administration*; D000070497:Healthy Lifestyle; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D019057:Quality-Adjusted Life Years; D013548:Sweden; D015431:Weight Loss
keywords: Cost-effectiveness; Diabetes; Lifestyle change; Markov model; Prevention