TY - JOUR
T1 - The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention
T2 - An intent-to-treat analysis of the DPP/DPPOS
AU - Herman, William H.
AU - Edelstein, Sharon L.
AU - Ratner, Robert E.
AU - Montez, Maria G.
AU - Ackermann, Ronald T.
AU - Orchard, Trevor J.
AU - Foulkes, Mary A.
AU - Zhang, Ping
AU - Saudek, Christopher D.
AU - Brown, Morton B.
PY - 2012/4
Y1 - 2012/4
N2 - 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.RESEARCH DESIGN ANDMETHODS - 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 directmedical 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.
AB - 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.RESEARCH DESIGN ANDMETHODS - 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 directmedical 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.
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U2 - 10.2337/dc11-1468
DO - 10.2337/dc11-1468
M3 - Article
C2 - 22442395
AN - SCOPUS:84861776112
SN - 0149-5992
VL - 35
SP - 723
EP - 730
JO - Diabetes care
JF - Diabetes care
IS - 4
ER -
