An evaluation of cost sharing to finance a diet and physical activity intervention to prevent diabetes

Ronald T. Ackermann*, David G. Marrero, Katherine A. Hicks, Thomas J. Hoerger, Stephen Sorensen, Ping Zhang, Michael M. Engelgau, Robert E. Ratner, William H. Herman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

68 Scopus citations


OBJECTIVE - The Diabetes Prevention Program (DPP) lifestyle intervention is a costeffective strategy to prevent type 2 diabetes, but it is unclear how this intervention could be financed. We explored whether this intervention could be offered in a way that allows return on investment for private health insurers while remaining attractive for consumers, employers, and Medicare. RESEARCH DESIGN AND METHODS - We used the DPP and other published reports to build a Markov simulation model to estimate the lifetime progression of disease, costs, and quality of life for adults with impaired glucose tolerance. The model assumed a health-payer perspective and compared DPP lifestyle and placebo interventions. Primary outcomes included cumulative incidence of diabetes, direct medical costs, quality-adjusted life-years (QALYs), and cost per QALY gained. RESULTS - Compared with placebo, providing the lifestyle intervention at age 50 years could prevent 37% of new cases of diabetes before age 65, at a cost of $1,288 per QALY gained. A private payer could reimburse $655 (24%) of the $2,715 in total discounted intervention costs during the first 3 intervention years and still recover all of these costs in the form of medical costs avoided. If Medicare paid up to $2,136 in intervention costs over the 15-year period before participants reached age 65, it could recover those costs in the form of future medical costs avoided beginning at age 65. CONCLUSIONS - Cost-sharing strategies to offer the DPP lifestyle intervention for eligible people between ages 50 and 64 could provide financial return on investment for private payers and long-term benefits for Medicare.

Original languageEnglish (US)
Pages (from-to)1237-1241
Number of pages5
JournalDiabetes care
Issue number6
StatePublished - 2006

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing


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