A recent follow-up of a randomised trial looked at the long-term costs of different ways of preventing type 2 diabetes in people with impaired glucose tolerance.
In people with impaired glucose tolerance and fasting hyperglycaemia, are lifestyle interventions, as compared to metformin or usual care, cost-effective?
This paper reports the costs and quality of life outcomes (as Quality-Adjusted Life Years or QALYs) from the long-term follow-up.
The data was from 2,766 patients who completed the 4-year Diabetes Prevention Program (DPP) trial that finished in 2001 and went on to enrol in a “maintenance” phase.
The lifestyle intervention comprised a core “curriculum” of diet and exercise interventions, supplemented by individualised sessions and group reinforcement sessions.
For 10 years, direct non-medical and medical costs were calculated for each treatment arm. These were collated against the QALYs for each group to calculate an incremental cost-effectiveness ratio.
- Lifestyle vs metformin: The cost per QALY gained was $13,420
- Lifestyle vs placebo: The cost per QALY was $10,037
- Metformin vs placebo: Metformin was cost-saving when compared with the placebo group.
Note that although metformin was cost-saving when compared with placebo, the lifestyle interventions were associated with better quality of life.
- Note that because of the way patients were recruited, the sample was not properly randomised at inception. Only 88% of the DPP participants went on to the maintenance phase.
- It seems likely that the participants in each group received co-interventions.
- Costs were based on patients at an early stage of disease and may be underestimates when translated to a broader population.
- Is the lifestyle intervention deliverable in your setting?
The full text is available from Diabetes Care:
The Diabetes Prevention Program Research Group. The 10-Year Cost-Effectiveness of Lifestyle Intervention or Metformin for Diabetes Prevention: An intent-to-treat analysis of the DPP/DPPOS. Diabetes Care April 2012 vol. 35 no. 4 723-730