The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: An intent-to-treat analysis of the DPP/DPPOS

William H. Herman*, Sharon L. Edelstein, Robert E. Ratner, Maria G. Montez, Ronald T. Ackermann, Trevor J. Orchard, Mary A. Foulkes, Ping Zhang, Christopher D. Saudek, Morton B. Brown

*Corresponding author for this work

Research output: Contribution to journalArticle

273 Scopus citations

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.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.

Original languageEnglish (US)
Pages (from-to)723-730
Number of pages8
JournalDiabetes care
Volume35
Issue number4
DOIs
StatePublished - Apr 1 2012

ASJC Scopus subject areas

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

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    Herman, W. H., Edelstein, S. L., Ratner, R. E., Montez, M. G., Ackermann, R. T., Orchard, T. J., Foulkes, M. A., Zhang, P., Saudek, C. D., & Brown, M. B. (2012). The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: An intent-to-treat analysis of the DPP/DPPOS. Diabetes care, 35(4), 723-730. https://doi.org/10.2337/dc11-1468