Clinical outcomes and cost-effectiveness of strategies for managing people at high risk for diabetes
Abstract
BACKGROUND: Lifestyle modification can forestall diabetes in high-risk people, but the long-term cost-effectiveness is uncertain.
OBJECTIVE: To estimate the effects of the lifestyle modification program used in the Diabetes Prevention Program (DPP) on health and economic outcomes.
DESIGN: Cost-effectiveness analysis using the Archimedes model.
DATA SOURCES: Published basic and epidemiologic studies, clinical trials, and Kaiser Permanente administrative data.
TARGET POPULATION: Adults at high risk for diabetes (body mass index >24 kg/m2, fasting plasma glucose level of 5.2725 to 6.9375 mmol/L [95 to 125 mg/dL], 2-hour glucose tolerance test result of 7.77 to 11.0445 mmol/L [140 to 199 mg/dL]).
TIME HORIZON: 5 to 30 years.
PERSPECTIVE: Patient, health plan, and societal.
INTERVENTIONS: No prevention, DPP's lifestyle modification program, lifestyle modification begun after a person develops diabetes, and metformin.
MEASUREMENTS: Diagnosis and complications of diabetes.
RESULTS OF BASE-CASE ANALYSIS: Compared with no prevention program, the DPP lifestyle program would reduce a high-risk person's 30-year chances of getting diabetes from about 72% to 61%, the chances of a serious complication from about 38% to 30%, and the chances of dying of a complication of diabetes from about 13.5% to 11.2%. Metformin would deliver about one third the long-term health benefits achievable by immediate lifestyle modification. Compared with not implementing any prevention program, the expected…
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